Trend in CV mortality among patients with mental disorder in the US between 1999–2020

Background

Patients with mental disorders are at increased risk of cardiovascular mortality. While the overall cardiovascular mortality rate in the western world is in decline, there is no up-to-date data on the cardiovascular mortality rates among patients with mental disorders. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental co-morbidities in the US.

Methods

Using Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death data set, we determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental disorders, from 1999 to 2020, stratified by mental disorders subtype, age, gender, race, and place of residence.

Results

Among more than 18.7 million cardiovascular deaths in the United States, 13.5% were patients with a concomitant mental disorder. During the study period, among patients with mental disorders, the age-adjusted mortality rate increased by 113.9% (vs 44.8% decline in patients with no mental disorder). In patients with mental disorders, the age-adjusted mortality rate increased more significantly among patients whose mental disorder in secondary to substance abuse (+532.6%) than among with organic mental disorders, such as dementia or delirium (+6.2%), while among patients with mood disorders the age-adjusted CV mortality rate dropped by 23.5%. Men patients, minorities, and residents of more rural areas experienced a more prominent increase in the age-adjusted cardiovascular mortality compared to women, white, and residents of metro areas.

Conclusions

While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders. The increase was more significant among patients with substance abuse-related mental disorders, in men, minorities, and residents of rural areas.

Funding Acknowledgement

Type of funding sources: None.

Intent, lethality and psychological characteristics of medically serious suicide attempters

Introduction

The study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. Such attempts are characterized by high suicide intent, together with high medical lethality. The ability to fully understand the specific psychological profiles associated with severe of suicide intent can provide insights for suicide prevention.

Objectives & aims

The objective of the present study was to investigate the relationship of suicide intent to lethality among medically serious suicide attempters. Our aim was to examine specific psychological variables related to the subjective and objective components within suicide intent.

Methods

102 suicide attempters belonged to one of two groups: 35 subjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All were interviewed and completed questionnaires covering mental pain, communication difficulties, and seriousness of the suicide intent.

Results

The objective component of the suicide intent scale (SIS) was highly correlated the lethality, as well as to communication difficulties, such as self disclosure while the subjective component of the SIS was related to mental pain variables such as depression and hopelessness. A significant interaction between mental pain and communication difficulties was found to predict severity of the objective suicide intent.

Conclusions

The suicidal person whom suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt - which is more planned, with more precautions against discovery and without communication before or during the attempts.

Imatinib: Major photocatalytic degradation pathways in aqueous media and the relative toxicity of its transformation products

Imatinib (IMA) is a highly potent tyrosine kinase inhibitor used as first-line anti-cancer drug in the treatment of chronic myeloid leukemia. Due to its universal mechanism of action, IMA also has endocrine and mutagenic disrupting effects in vivo and in vitro, which raises the question of its environmental impact. However, to date, very little information is available on its environmental fate and the potential role of its transformation products (TPs) on aquatic organisms. Given the IMA resistance to hydrolysis and direct photolysis according to the literature, we sought to generate TPs through oxidative and radical conditions using the AOPs pathway. Thus, the reactivity of the cytotoxic drug IMA in water in the presence of OH and h+ was investigated for the first time in the present work. In this regard, a non-targeted screening approach was applied in order to reveal its potential TPs. The tentative structural elucidation of the detected TPs was performed by LC-HRMSⁿ. The proposed approach allowed detecting a total of twelve TPs, among which eleven are being described for the first time in this work. Although the structures of these TPs could not be positively confirmed due to lack of standards, their chemical formulas and product ions can be added to databases, which will allow their screening in future monitoring studies. Using the quantitative structure-activity relationship (QSAR) approach and rule-based software, we have shown that the detected TPs possess, like their parent molecule, comparable acute toxicity as well as mutagenic and estrogenic potential. In addition to the in silico studies, we also found that the samples obtained at different exposure times to oxidative conditions, including those where IMA is no longer detected, retained toxicity in vitro. Such results suggest further studies are needed to increase our knowledge of the impact of imatinib on the environment.

Modeling of hospital wastewater pollution by pharmaceuticals: first results of Mediflux study carried out in three French hospitals

A study has been carried out in three French hospitals in order to assess and model the pharmaceutical load in hospital wastewater and its impact in WWTP. This study, called Mediflux, consisted of three successive steps: first, an original prioritization procedure developed in our laboratory enabled us to select a list of relevant molecules from different Anatomical Therapeutic Chemical (ATC) classes containing pharmaceuticals for specific hospital use such as anesthetics or antineoplastic agents and pharmaceuticals dispensed in the community. Then, analytical quantification procedures were developed and validated according to 2002/657/EC European directive. Sampling campaigns were performed in three different hospitals, two located in the Paris area and one in a medium-sized city 150 km from Paris. Sampling was also carried out in wastewater treatment plants. At the same time, in order to model the pharmaceutical loads from hospitals, predicted concentrations were calculated as a first approach assuming it would be a single-box model, i.e. hospitals have no effect on drug loads and only human metabolism is taken into account to evaluate the fraction of drugs eliminated in hospital effluent. In the last step, the comparison of measured and calculated concentrations showed a satisfactory correlation for some pharmaceuticals, mainly those with short elimination half-lifes and weak human metabolism. For others, it appeared that modeling should take into account various factors such as out patient use, pharmacokinetic data and molecule stability in wastewater.

Systemic lupus erythematosus in Europe at the change of the millennium: lessons from the "Euro-Lupus Project"

The "Euro-Lupus Cohort" is composed by 1000 patients with systemic lupus erythematosus (SLE) that have been followed prospectively since 1991. These patients have been gathered by a European consortium--the "Euro-Lupus Project Group". This consortium was originated as part of the network promoted by the "European Working Party on SLE", a working group created in 1990 in order to promote research in Europe on the different problems related to this disease. The "Euro-Lupus Cohort" provides an updated information on the SLE morbidity and mortality characteristics in the present decade as well as defines several clinical and immunological prognostic factors.

The prevalence of obesity and associated morbidity among 17-year-old Israeli conscripts

BACKGROUND

There has been a significant increase in the prevalence of obesity among children and adolescents over the last few decades. Obesity is associated with significant psychosocial and physical morbidity.

OBJECTIVE

The aim of this study was to define the prevalence of obesity and associated morbidity, including type 2 diabetes and hypertension, among 17-year-old adolescents. A comparison between the morbidity patterns of females and males was also performed.

DESIGN

All 17-year-old Israeli nationals are obliged by law to present at the Israel Defence Forces recruiting office for a medical examination, with the exception of orthodox religious and Arabic adolescents. Height and weight are measured and classified, and a trained specialist evaluates those with suspected associated diseases. The level of education is also recorded.

RESULTS

Our survey included 76,732 adolescents, 32,402(42.2%) females and 44,330(57.8%) males. The prevalence of obesity and morbid obesity among 17-year-old Israeli conscripts was 4.1% in males and 3.3% in females. The prevalence of borderline overweight was 12.4% in males and 11.4% in females. The prevalence of hypertension and type 2 diabetes was significantly higher among conscripts with BMI>30 kg/m2 in both genders. There was also a significantly higher prevalence of hypertension and type 2 diabetes in males compared with females(P<0.001, 0.015). A significantly higher prevalence of conscripts without high-school education(<10 years of education) was found among females with BMI>30 kg/m2. There was no significant difference among the male conscripts.

CONCLUSIONS

This study found a relatively low prevalence of obesity among 17-year-old Israeli conscripts, but an alarmingly high prevalence of borderline overweight. Obesity was correlated with a higher prevalence of hypertension and type 2 diabetes, and a lower level of education. There was a significant difference between genders in the prevalence of hypertension and type 2 diabetes, and this should be further investigated. These data call for the creation of new education programmes on the prevention of overweight among children and adolescents.

Studies of BDOC and bacterial dynamics in the drinking water distribution system of the Northern Parisian suburbs

The deterioration of water quality in distribution systems due to bacterial regrowth is, at the present time, a major concern of drinking water producers. In this context, a good knowledge of the factors controlling bacterial development is required; the aim of the present study is to understand the rote of biodegradable dissolved organic carbon (BDOC) in the bacterial dynamics of the distribution system.

This paper discusses the results obtained in a study carried out in order to assess the dynamics of biodegradable dissolved organic carbon and suspended bacteria in the water distribution system of the Northern Parisian suburbs lad by the Méry-sur-Oise treatment plant.

The results show clearly that a significant decrease in BDOC occurs within the smallest pipes, when the BDOC level in the finished water is higher than about 0.20 mgC.L-1. However, no decrease in BDOC is observed when the BDOC in the finished water is lower than 0.16 mgC.L-1. The bacterial abundance in the distribution system is primarily linked to the absence of free chicane. Temperature and BDOC concentration in the finished water are also major controlling factors of bacterial numbers. Bacterial growth rates are in the range 0.005 to 0.1 h-1 in the absence of free chlorine, the highest of these values are in the same range as the growth rates measured for bacteria in natural aquatic ecosystems. Fixed biomass to the inner pipes surface are in the range 0.25 to 0.65 µgC.cm-2 and the average growth rate of fixed bacteria seems to be roughly in the same order of magnitude as the average growth rate of the suspended bacteria.

A model of the dynamics of BDOC and bacteria in distribution network, incorporating the knowledge gained from this and previous studies concerning the control of bacterial activity by dissolved organic matter, is presented. It involves a mathematical representation of the kinetics of bacterial adsorption-desorption processes, bacterial attachment, bacterial utilization of biodegradable dissolved organic matter and impact of chlorine on free and fixed bacteria. It allows simulation of the impact of reducing the BDOC in the finished water on processes associated with bacterial regrowth in the distribution network..

Effet du chlore sur la colonisation bactérienne d'un réseau expérimental de distribution d'eau

La contamination bactérienne de la phase eau d'un réseau de distribution résulte d'une multiplication des bactéries sur les parois des canalisations d'eau (biofilms) suivie de leur arrachage et de leur transport dans le flux circulant. Ce travail met en évidence l'effet du chlore, d'une part, sur la formation des biofilms et, d'autre part, sur des biofilms déjà constitués. Des éprouvettes de matériaux neufs introduites dans des eaux présentant des concentrations en chlore total variant de 2,4 à 0,02 mg/l et véhiculant entre 0,5 x 106 et 5 x 105 cellules bactériennes/mi (dont 1 à 10 % de bactéries cultivables) sont rapidement colonisées (106 à 108 cellules/cm2). L'effet du chlore est sensible sur les cellules totales pour des concentrations de l'ordre de 1 à 2,4 mg/l. Sur les bactéries cultivables, un ralentissement de la croissance du biofilm est observé dès 0,3 mg/1 de chlore total. Par contre, des résiduels de 0,02 ou 0,05 mg/l sont sans effet sur la cinétique de formation des biofilms. Des résiduels moyens de chlore total compris entre 2,3 et 3,4 mg/l appliqués en continu pendant 14 jours sur un biofilm constitué d'environ 8,7 x 106 cellules par cm2 (1,7 % de bactéries cultivables), entraînent l'élimination d'environ 90 % des bactéries fixées (abattement d'1 logarithme) durant les premiers jours d'exposition. L'altération du biofilm exposé à un résiduel de chlore total de l'ordre de 1,3 mg/l est identique, mais toutefois plus étalée dans le temps. Ces essais réalisés sur des éprouvettes de PVC, PE et mortier de ciment n'ont pas permis la mise en évidence de comportements différents de ces 3 supports..

Biodegradable dissolved organic carbon removal during biological filtration on granular actived carbon

In drinking water production, filtration on granular activated carton (GAC) is generally used in order to remove by adsorption the dissolved organic matter. Nevertheless, the adsorption capacity of GAC is rapidly saturated and it is so necessary to regenerate the GAC. An interesting alternate has been applied in some treatment plants. It consists to use GAC filtration without regeneration taking benefit of the activity of the microbial community which colonize the GAC particles (RITTMAN and HUCK, 1989). In fact, this biological filtration offers the advantage to specially remove the biodegradable fraction of the dissolved organic carbon (BDOC), which is responsible for the problem of bacterial growth into the distribution networks.

The bacterial nature of the BDOC removal achieved by the biological filtration on GAC has been now clearly demonstrated (SERVAIS et al., 1991) and some important results of the functioning of these filters has been obtained in studies conducted on pilots filters (BOUILLOT et al., 1990; SERVAIS et al., 1992). These studies have for example shown that only a very small part of the bacterial biomass produced in the filter is exported with the outflow.

In the present study, biological filtration has been investigated in a full scale treatment line at Choisy-le-Roi in the Parisian suburbs and the results compared with those gained on pilot filters.

The working conditions of the three GAC filter studied are presented in table 1 and compared with those of pilot filters used in a previous study conducted al Neuilly-sur-Marne (table 2). The microbial colonization has been followed in two of the liners. If lasted roughly 3 months to reach biological equilibration, it corresponds to a water volume filtrated of 12 500 m3 per m3 of GAC. Efficiency of the removal during this period is presented in figure 2. Progressively, biological processes take turn with adsorption (fig. 1).

As already demonstrated by SERVAIS et al. (1992), the efficiency of biological filtration, calculated in percentage of BDOC removal, increases with increasing contact time whatever the filtration velocity could be in the range 2 m/h to 18 m/h (fig. 3). However, the percentage of BDOC, at similar temperature, is higher in the GAC filters at Choisy-le-Roi than at Neuilly-sur-Marne. The fixed bacterial biomass is also higher at Choisy-le-Roi (average 7.5 µgC/cm3) than at Neuilly-sur-Marne (average 2 µC/cm3).

Following during two years the functioning of the n° 56 and 38 filters (tables 3, 4 and fig. 5, 7), it seems that the global efficiency of filtration is better in 1990 than in 1989. This can be linked to the greater fluctuations in BDOC in the influent water in 1989 than in 1990, as shown on figure 8. Fluctuations in the quality of the influent water requires a period to reach the equilibrium during which the effluent is charchacterized by a lower quality (fig. 8). This period is longer at low temperature.

The mathematical modal based on the kinetics of the basic microbiological processes involved in biological filtration (the CHABROL model) has been previously developed (BILLEN et al., 1992) in order la simulate the performances of the filtration. It can be used to simulate the vertical profiles of BDOC and bacterial biomass in the filters of the Choisy-le-Roi treatment plant, with modifying only one parameter in the model, the average bacterial mortality “kd” (fig. 4). BDOC decreases versus empty bed contact time (EBCT) calculated by the modal are presented on figure 6 for the Choisy-le-Roi and Neuilly-sur-Marne treatment plants and for two temperatures.

From a management point of view, the minimum BDOC is reached for contact time between 15 and 20 minutes at Neuilly-sur-Marne, while at Choisy-le-Roi it is rather between 10 and 15 minutes.

In conclusion, BDOC measurements and CHABROL modal constitute powerful tools for management and design of biological GAC filters.

Monitoring genotoxicity during the photocatalytic degradation ofp-nitrophenol

p-Nitrophenol is a common structural unit of many pesticides and was chosen as a model compound to monitor genotoxicity during photocatalytic degradation. The genotoxicity of p-nitrophenol (PNP) and its breakdown products was measured using a bioluminescent bacterial bioassay, Vitotox. The genotoxic potential decreased with the concomitant photocatalytic degradation of the parent PNP concentration. The rate of genotoxicity reduction was slower than the rate of removal of the parent PNP, due to the formation of genotoxic by-products. After 6 h of photocatalytic treatment the total genotoxicity was removed. These results indicate that bioassays can be used as a simple and highly sensitive method for monitoring the general toxicity of chemical pollutants before, during and after photocatalytic treatment or other destructive processes.

Convergent Effects on Cell Signaling Mechanisms Mediate the Actions of Different Neurobehavioral Teratogens: Alterations in Cholinergic Regulation of Protein Kinase C in Chick and Avian Models

Although the actions of heroin on central nervous system (CNS) development are mediated through opioid receptors, the net effects converge on dysfunction of cholinergic systems. We explored the mechanisms underlying neurobehavioral deficits in mouse and avian (chick, Cayuga duck) models. In mice, prenatal heroin exposure (10 mg/kg on gestation days 9-18) elicited deficits in behaviors related to hippocampal cholinergic innervation, characterized by concomitant pre- and postsynaptic hyperactivity, but ending in a reduction of basal levels of protein kinase C (PKC) isoforms betaII and gamma and their desensitization to cholinergic receptor-induced activation. PKCalpha, which is not involved in the behaviors studied, was unaffected. Because mammalian models possess inherent confounding factors from maternal effects, we conducted parallel studies using avian embryos, evaluating hyperstriatal nucleus (intermedial part of the hyperstriatum ventrale, IMHV)-related, filial imprinting behavior. Heroin injection to the eggs (20 mg/kg) on incubation days 0 and 5 diminished the post-hatch imprinting ability and reduced PKCg and bII content in the IMHV membrane fraction. Two otherwise unrelated agents that converge on cholinergic systems, chlorpyrifos and nicotine, elicited the same spectrum of effects on PKC isoforms and imprinting but had more robust actions. Pharmacological characterization also excluded direct effects of opioid receptors on the expression of imprinting; instead, it indicated participation of serotonergic innervation. The avian models can provide rapid screening of neuroteratogens, exploration of common mechanisms of behavioral disruption, and the potential design of therapies to reverse neurobehavioral deficits.

[Molecules used for therapeutic or diagnostic purposes are micro water polluants]

Molecules used for therapeutic or diagnostic purposes have been identified and quantified in Europe and North America in surface and ground waters used for production of drinking water. When mixed with other organic compounds such as pesticides, hydrocarbons, or plasticizers which may present endocrine-disturbing or genotoxic effects, such molecules may, even in low concentrations, present an ecotoxicological or public health hazard. For this reason, healthcare professionals involved in drug production as well as drug users must take care to limit release of such molecules into the environment. Work on environmental behavior of marketed products and on health hazard assessment must be favored in order to acquire appropriate knowledge of the environmental and health risks.

An ATP-based method for monitoring the microbiological drinking water quality in a distribution network

The titration of adenosine triphosphate (ATP) by bioluminescence permits rapid evaluation of the quantity of viable micro-organisms present in a water sample. During two sampling campaigns, Société Anonyme de Gestion des Eaux de Paris (SAGEP) tested a new extraction and titration system of bacterial ATP in the Paris drinking water distribution network. As far as the entire set of results of analyses of water in the network is concerned there is a linear relationship between log [ATP] and log(HPC-R2A/ml). Furthermore, as regards the drinking water originating from treatment of surface waters, some of the results obtained indicate a slight change as regards the Paris network in the microbiological quality. This is certainly linked to the distance travelled from the production location as well as to a reservoir effect observed on a site. Conversely, no change is apparent with regard to waters of underground origin. Lastly, despite changes in temperature and chlorine residual, no significant influence has been observed, essentially because of the very low density of culturable bacteria.

Lessons from the "Euro-Lupus Cohort"

The "Euro-Lupus Cohort" is composed by 1,000 patients with systemic lupus erythematosus (SLE) that have been followed prospectively since 1991. These patients have been gathered by a European consortium - the "Euro-Lupus Project Group". This consortium was originated as part of the network promoted by the "European Working Party on SLE", a working group created in 1990 in order to promote research in Europe on the different problems related to this disease. The "Euro-Lupus Cohort" provides an updated information on the SLE morbidity and mortality characteristics in the present decade as well as defines several clinical and immunological prognostic factors.

A colorimetric and fluorometric microplate assay for the detection of microcystin-LR in drinking water without preconcentration

Protein phosphatase inhibition assays currently used for the detection of cyanobacterial peptide hepatotoxins in drinking water require an enrichment step using C18 cartridges to achieve lower the detection limit. This paper describes a colorimetric and fluorometric protein phosphatase inhibition method for the direct detection of microcystin-LR (MCYST-LR) in drinking water without complex clean-up steps and preconcentration procedures. In this assay three different substrates, p-nitrophenyl phosphate (p-NPP) and two fluorogenic compounds, 4-methylumbelliferyl phosphate (MUP) and 6,8-difluoro-4-methylumbelliferyl phosphate DiFMUP), were tested. The detection limits of the assay are 0.25 and 0.1 microg/l using colorimetric and fluorometric methods, respectively. These levels are well below the provisional guideline value for MCYST-LR of 1 microg/l of drinking water. The detection limit of the fluorometric method is comparable to that of the classical ELISA test. Although both the latter tests allow the detection of MCYST-LR in drinking water directly without pretreatment, the protein phosphatase inhibition assay remain less expensive and therefore more attractive for use in the routine assessment of drinking water contamination by microcystins.

[Morbidity and mortality in systemic lupus erythematosus]

Systemic lupus erythematosus is an autoimmune disease that can affect any organ system, mostly central and peripheral nervous system, lungs, heart, kidneys, skin, serous membranes, and components of blood. Lupus is more prevalent in females, has no etiology, and has a distinct association with several immune response genes. Understanding and treatment of lupus has progressed in the last decade, contributing to the improvement in survival and quality of life. Improvement in prognosis is associated with many factors including the socioeconomic state, advanced medicine, and access to medical sources. Three aspects of the disease are necessary to establish and describe the prognosis in SLE: disease activity, accumulated damage, and health status/quality of life.

Use of the SpaceMaker balloon in sternal wound closure: comparison with other techniques

Sternal wound infection is surgically treated by debridement of the infected sternum and closure of the defect with a muscular flap. These operations tend to be long, stressful, and time-consuming and to involve heavy blood loss. To facilitate wound closure, the SpaceMaker balloon was applied intraoperatively to expand the pectoralis major muscles and enable tensionless closure with musculocutaneous flaps. The aim of the present study was to compare the effectiveness and feasibility of this technique with a variety of others described in the literature. The study population consisted of 40 consecutive patients with sternal wound infection following median sternotomy who were treated with the advancement flap, turnover flap, transposition flap, or SpaceMaker balloon-assisted advancement flap technique (n = 10 each). The balloon-assisted technique was associated with a shorter length of operation and fewer blood transfusions than the other methods. Furthermore, there was no need for reoperation and there were no cases of skin necrosis. In conclusion, closure with the SpaceMaker balloon-assisted bilateral pectoralis major musculocutaneous flap may serve as an adjunctive measure in the treatment of sternal wound infection. This technique seems to have advantages over simple pectoralis major musculocutaneous advancement, particularly for midsternal wounds.

[Dopamine in acute renal failure]

Dopamine is widely used for prevention and treatment of acute renal failure. Its application is based on physiological data suggesting a selective renal effect when it is administrated at a low dose. There is no evidence that dopamine is useful in preventing acute renal failure in patients undergoing high risk procedures. Most of the studies demonstrated lack of benefit from dopamine treatment in cases of acute renal failure. Dopamine has a number of known side-effects. Large randomized controlled trials are required in order to examine outcomes such as mortality, the need for dialysis or the length of hospitalization.

CONCLUSION

The use of dopamine for prevention and treatment of acute renal failure should be avoided.

[Following 90 patients with antiphospholipid syndrome with antibody titers and correlations with clinical manifestations: symptoms of the disease, a new antibody and correlations with clinical manifestations in the Israeli population]

The antiphospholipid syndrome (APS) is defined by the presence of antiphospholipid antibodies (aPLs) with venous or arterial thrombosis, recurrent pregnancy loss or thrombocytopenia. The syndrome can be either primary or secondary to an underlying condition, most commonly systemic lupus erythematosus (SLE). The purpose of the study was to review the manifestations of the APS in Israeli patients and to investigate the difference between patients with primary or secondary syndrome. Analysis of the correlation between the manifestations of the disease and the antibody titers [LA (lupus anticoagulant), IgG aCL (anticardiolipin), IgM aCL] was also performed. In the study there were 90 patients with APS in the Sheba Medical Center. The clinical findings for all patients were recorded according to established protocol.

RESULTS

Arterial thrombotic events were present in 51.1% of the patients; cerebral ischemic attacks were the most frequent arterial events. Venous thrombotic events were present in 45.6% patients; deep venous thrombosis was the most frequent venous event. Obstetric complications were found in 37.3% of patients; the most frequent complication was abortions. The clinical findings of patients with primary or secondary syndrome were similar. Patients with APS associated with lupus had a high prevalence of hemolytic anemia (28.6% v 3.3%; P = 0.001), and ANA (antinuclear antibody) (75% v 12.9%; P = 0.0001). There was no correlation between the antibody titers (LA, IgG aCL, IgM aCL) and clinical manifestations. The patients received anticoagulant treatment and antiaggregant drugs to prevent recurrence of symptoms. Clinical manifestations in Israeli patients did not differ from those in non-Israeli patients.

CONCLUSIONS

Venous or arterial thrombosis and obstetric complications are the most frequent clinical findings in APS. There was no different in clinical manifestations between primary and secondary syndrome. The findings of autoimmune hemolytic anemia and ANA were more frequent in patients with secondary APS. There was no correlation between antiphospholipid antibody titers and manifestations of disease. Overall, the patients require therapy with anticoagulant treatment and antiaggregant drugs. The clinical manifestations were similar in Israeli and non-Israeli patients.

[Neurological manifestations in West Nile fever]

The West Nile fever is a viral disease transferred by a mosquito bite. It is well known in the world for the last 70 years. Recently, there was an outbreak of this disease in Israel. We will describe case reports of 2 patients who were afflicted by the disease. The first one was hospitalized with an unusual presentation including paralysis to the lower limbs, while the second one was admitted with meningitis. In both, the course was quite dramatic, and one of them expired. Reviewing the literature revealed that neurological manifestations are quite frequent among these patients (90%), while in elder people, they were fatal.

Bacterial responses to ultraviolet irradiation

The UV dose-response behavior of laboratory cultures of waterborne bacteria were examined for UV doses ranging from ca. 0-100 mW.s/cm2 using a collimated-beam reactor. Specific physiological responses measured in these tests included viability (ability to reproduce) and respiration (oxygen uptake rate). The results of these exposures indicated that resistance to UV-imposed loss of viability in E. coli cultures can be partially attributed to agglomeration during the irradiation process. From these results, it is conjectured that a bacterial population may be comprised of two sub-populations: one with low resistance (discrete or paired cells) and a second with high resistance (bacterial aggregates). A small fraction of the high-resistance portion of the population appears to be essentially unaffected by UV irradiation, thereby causing a discontinuity in the measured dose-response behavior. Moreover, the dose-response behavior of the highly resistant fraction is variable and difficult to describe quantitatively. The basis of these statements and most information in the literature is microbial viability as quantified by the membrane filtration assay. In contrast to these findings, the results of analyses for bacterial activity (respiration) suggest that comparatively little change in the population can be found to result from UV irradiation. This suggests that UV radiation accomplishes inactivation of the bacteria, but does not "kill" the bacterial cells per se, thereby highlighting the importance of considering bacterial repair processes in the design of UV disinfection systems.

Factor VII deficiency in a patient with retinal arteriolar tortuosity syndrome

PURPOSE

To report a pedigree with hereditary retinal arteriolar tortuosity with macular haemorrhage and abnormality of the coagulation system.

METHODS

Case report and literature review.

RESULTS

A 49-year-old woman was referred due to macular haemorrhage in both eyes. Her 16-year-old son had recurrent retinal haemorrhages which presented at age 16 years and had mild retinal arteriolar tortuosity. Coagulation studies in the son revealed normal activated partial thromboplastin time (APTT), prolonged prothrombin time (PT) and 30% activity of factor VII.

CONCLUSIONS

Factor VII deficiency may aggravate the haemorrhages in retinal arteriolar tortuosity syndrome. We therefore suggest conducting routine coagulation studies (PT, APTT) in all patients with retinal arteriolar tortuosity syndrome. Determination of factor VII activity is warranted only in patients with normal APTT and prolonged PT.

Do high impact exercises produce higher tibial strains than running?

BACKGROUND

Bone must have sufficient strength to withstand both instantaneous forces and lower repetitive forces. Repetitive loading, especially when bone strain and/or strain rates are high, can create microdamage and result in stress fracture

AIM

To measure in vivo strains and strain rates in human tibia during high impact and moderate impact exercises.

METHODS

Three strain gauged bone staples were mounted percutaneously in a rosette pattern in the mid diaphysis of the medial tibia in six normal subjects, and in vivo tibial strains were measured during running at 17 km/h and drop jumping from heights of 26, 39, and 52 cm.

RESULTS

Complete data for all three drop jumps were obtained for four of the six subjects. No statistically significant differences were found in compression, tension, or shear strains with increasing drop jump height, but, at the 52 cm height, shear strain rate was reduced by one third (p = 0.03). No relation was found between peak compression strain and calculated drop jump energy, indicating that subjects were able to dissipate part of the potential energy of successively higher drop jumps by increasing the range of motion of their knee and ankle joints and not transmitting the energy to their tibia. No statistically significant differences were found between the principal strains during running and drop jumping from 52 cm, but compression (p = 0.01) and tension (p = 0.004) strain rates were significantly higher during running.

CONCLUSIONS

High impact exercises, as represented by drop jumping in this experiment, do not cause higher tibial strains and strain rates than running and therefore are unlikely to place an athlete who is accustomed to fast running at higher risk for bone fatigue.

Sonographically thick placenta: a marker for increased perinatal risk--a prospective cross-sectional study

The aim of this study was to determine placental thickness by ultrasound examination throughout pregnancy and establish the correlation of sonographically thick placenta with perinatal mortality and morbidity. Placental thickness was determined by routine sonographic examination throughout pregnancy in 561 normal singleton pregnancies. Thick placenta was determined as placenta that was above the 90th percentile. Gravidae between 20-22 weeks' gestation (n=193) and 32-34 weeks (n=73) were then divided into two groups according to placental thickness. The study group consisted of 44 gravidae with thick placenta. The control group included 151 gravidae with placental thickness between the 10th and 90th percentile. A comparison of perinatal mortality and morbidity rates as well as the incidence of small and large for gestational age neonates was conducted.A linear increase of placental thickness was found to correlate with gestational age throughout pregnancy. No statistical differences were observed between the two groups with regard to obstetrical variables such as maternal age, parity and gestational age at delivery. No correlation was found between placental thickness and maternal age or parity. The incidence of perinatal mortality was significantly higher among gravidae with thick placentae (6.82% versus 0.66 per cent, P=0.037, 95 per cent confidence interval 1.71-70.29). Birthweight at term was found to be above 4000 g in 20.45 per cent of the thick-placenta group as compared to 5.3 per cent in the control group (P=0.001, 95 per cent CI 2.08-13.85), and birthweight of less than 2500 g was found in 15. 9 per cent of the thick-placenta group as compared to 7.3 per cent in the control group (P=0.03, 95 per cent CI 1.11-8.14). The incidence of fetal anomalies was 9.1 per cent in the thick-placenta group and 3.97 per cent in the control group (not significant). Sonographically thick placenta is associated with increased perinatal risk with increased mortality related to fetal anomalies and higher rates of both small for gestational age and large for gestational age infants at term.

Effect of a mineral salt diet on 24-h blood pressure monitoring in elderly hypertensive patients

The influence of a mineral salt on 24-h ambulatory blood pressure (BP) monitoring was studied in 20 elderly hypertensive subjects residing in an old peoples home. Ordinary table and cooking salt was substituted with a special Na-reduced, K-, Mg-, and l-lysine HCl-enriched mineral salt (Pansalt(R)) for 6 months. Antihypertensive therapy was uninterrupted. An ambulatory BP monitor (Suntech Accutracker) measured BP every 20 min during the day and every 30 min at night, before and 6 months after starting the diet. Nine patients (45%) decreased both systolic and diastolic BP significantly: systolic BP fell from 154.92 +/- 33.67 mm Hg to 143. 45 +/- 53.1 mm Hg (P < or = 0.01) during the daytime from 6 am to midnight; and from 139.80 +/- 32.84 mm Hg to 137.87 +/- 31.17 mm Hg (P < or = 0.01) from midnight to 6 am. Diastolic BP fell from 85.34 +/- 24.85 mm Hg to 70.29 +/- 18.31 mm Hg (P < or = 0.01) during the daytime from 6 am to midnight; and from 77.1 +/- 22.92 mm Hg to 67.76 +/- 15. 63 mm Hg (P < or = 0.01) at night. Blood pressure in the other 11 subjects showed no improvement. Heart rate also fell in the subjects, from 69.44 +/- 21.62 beats per minute (bpm) to 66.94 +/- 11.51 bpm (< or = 0.01) during the day, and from 61.28 +/- 12.82 bpm to 60.43 +/- 10.33 bpm (P < or = 0.01) during the night. It is concluded that decreased intake of Na and increased intake of both K and Mg can be useful in controlling high BP.

Anti-idiotype immunomodulation of experimental anti-phospholipid syndrome via effect on Th1/Th2 expression

Mice with experimental anti-phospholipid syndrome (APS), induced by active immunization with a human anti-cardiolipin MoAb (H-3), were treated with mouse anti-idiotypic MoAb (anti-H3, named S2.9) and with an irrelevant anti-idiotype. The immunized mice produced high titres of mouse anti-cardiolipin antibodies along with clinical manifestations of experimental APS: prolonged activated partial thromboplastin time (aPTT), thrombocytopenia and high rate of fetal loss. Treatment with the specific anti-Id (S2.9) as a whole molecule or F(ab)2 fraction, resulted in a decrease in serum levels of the anti-cardiolipin antibodies, rise in platelet count, shortened aPTT and reduced rate of fetal loss. The anti-Id effect was associated with a rise in the number of IL-2 and interferon-gamma (IFN-gamma)-secreting cells (Th1) and reduction in IL-4- and IL-6-secreting cells (Th2). The beneficial effect of the anti-Id treatment in mice with experimental APS induced by active immunization with an idiotype further supports the idiotypic aetiology of experimental APS and points to the role of Th1 cytokines in suppression of its manifestations.

Campylobacter bacteremia and pneumonia in two splenectomized patients

Two patients with beta thalassemia who had undergone splenectomy for hypersplenism were admitted to the hospital with high fever and lobar pneumonia. Neither patient had gastrointestinal symptoms. Campylobacter bacteremia was diagnosed in both patients. Campylobacter jejuni was identified in the first patient and Campylobacter fetus in the second. Both patients were treated with broad-spectrum antibiotics and recovered fully.

[Malignant nodular hidradenoma--sweat gland tumor]

Malignant hidradenoma is a very rare tumor that originates from sweat glands. We present a 61-year-old man with an ulcerated tumor in his right flank, 4 cm in diameter, that was excised with a wide free margin. Histopathologic study showed an ill-defined, epithelial neoformation, formed by lobules of clear polygonal cells in the deep dermis and subcutaneous tissue, diagnosed as malignant nodular hidradenoma. 1.5 years after excision there was enlargement of the right axillary and inguinal lymph nodes, which showed metastatic, adnexal neoplastic cells. Axillary resection and superficial dissection of the right inguinal nodes were performed. After 3 months the tumor had spread to other lymph nodes and acute obstructive renal failure required insertion of a pig-tail catheter into the right ureter. Radiotherapy was followed by chemotherapy, but he died from end-stage metastatic disease in multi-organ failure.

Immunomodulation of murine experimental SLE-like disease by interferon-gamma

The objective of this study was to assess the impact of murine recombinant IFN-gamma and anti-IFN-gamma monoclonal antibody on the BALB/c mice experimental model of lupus. BALB/c female mice were immunized with a human anti-DNA antibody that carries the 16/6 idiotype. These mice were divided into several therapeutic groups according to different treatment strategies; injection with mouse recombinant IFN-gamma, anti-IFN-gamma mAb, phosphate-buffered saline (PBS), irrelevant mouse IgG and control groups that were neither treated nor immunized with the human anti-DNA antibody. The administration of IFN-gamma, intensified the degree of clinical, histological and serological parameters in this model of BALB/c murine lupus. This immunomanipulation decreased the mice longevity. All the laboratory parameters reflected acceleration of the disease in the IFN-gamma treated group as an elevated sedimentation rate, decreased white blood cell count and the development of massive proteinuria. One month after the boost injection, all the mice that were immunized with the anti-DNA antibody, developed high titers of autoantibodies; however, following an additional month, their levels declined in the IFN-gamma treated group. These findings were in concordance with an increased glomerular deposition of immune complexes in the IFN-gamma treated mice. IFN-gamma upregulated the levels of IL-4 and increased the number of IL-4 and IL-6 secreting splenocytes. In conclusion IFN-gamma administration can aggravate the clinical and laboratory outcome of 16/6 id induced lupus in BALB/c mice.

Calcium-induced activation of the mitochondrial permeability transition in hippocampal neurons

The mitochondrial permeability transition (mPT) has been implicated in both excitotoxic and apoptotic neuronal cell death, despite the fact that it has not been previously identified in neurons. To study the mPT in hippocampal neurons, cultures were loaded with the mitochondrial dye JC-1 and observed with confocal and conventional microscopy. After pretreatment with 4Br-A23187 and subsequent calcium addition, the initially rodlike mitochondria increased in diameter until mitochondria became rounded in appearance. Morphological changes reversed when calcium was removed by EGTA. When neurons were loaded with both fura-2-AM and rhodamine 123, calcium loading produced an increase in cytosolic calcium, mitochondrial depolarization, and similar alterations in mitochondrial morphology. Smaller calcium challenges produced calcium cycling, delaying morphological changes until after secondary depolarization and calcium release to the cytosol. In neurons exposed to glutamate, confocal observation of JC-1 fluorescence revealed comparable changes in mitochondrial morphology that were prevented when barium was substituted for calcium, or following pretreatment with the mPT inhibitor, cyclosporin A. These experiments establish conditions in which the mPT could be observed in situ in neurons in response to calcium loading. In addition, the timing of changes suggested that induction of the permeability transition in situ represents a sequence of multiple events that may reflect the multiple open conformations of the mPT pore.

[Viagra--the first oral treatment for impotence that is not lacking in fatal effects]

Impotence, a common problem especially among older men, can now be treated with Viagra, This oral pill, unlike previous approved treatments mostly involving local injections, does not directly cause penile erection, but increases response to sexual stimulation. It acts by enhancing the relaxant effects of nitric acid on smooth muscle, and thus increases blood flow to certain areas of the penis, leading to erection. It has been evaluated in many randomized trials and in all was more successful in inducing erection than placebos. The most common side-effects include headache, flushing and indigestion, but there have also been reports of fatalities. We describe a 75-year-old man who had an acute myocardial infraction in the past and who had maturity-onset diabetes and hypertension. In the week prior to admission he had a cardiac scan following a few weeks of exacerbation of anginal pain for which he had been taking nitrites. He took a Viagra pill without prescription or medical advice and 2 hours later, during intercourse with his wife, developed audible respiratory distress and lost consciousness. His wife started cardiac massage but not mouth-to-mouth breathing. The emergency team found ventricular fibrillation and gave 5 electrical shocks and amines and atropine. He remained unconscious, but his pulse returned and he was hospitalized. He then had several generalized convulsions treated with i.v. valium. 20 minutes after admission there was asystole and all attempts at resuscitation failed. Cardiovascular status must be considered prior to prescribing Viagra, and the associated risk evaluated.

Primary biliary cirrhosis. Is (and how much of) the pathology preventible?

Primary biliary cirrhosis (PBC) is a chronic, progressive cholestatic liver disease, which is invariably fatal. Circumstantial and indirect evidence suggests that autoimmune mechanisms have a role in the pathogenesis of PBC. Antimitochondrial antibodies (AMA) are highly sensitive and specific markers that can predict the development of the disease in a healthy individual. Long-term administration of ursodeoxycholic acid (UDCA), a naturally occurring bile acid, safely slows the progression of PBC, delays the need for liver transplantation, and postpones death. An effort should be made to identify the patients with PBC in the asymptomatic stage by the presence of AMA and to conduct a clinical trial in order to assess the benefit of long-term administration of UDCA on the prevention of the overt disease in these individuals.

Enterovirus genomes in wastewater: concentration on glass wool and glass powder and detection by RT-PCR

Standard methods for detecting enteroviruses in environmental samples require cell culture, which is time consuming and expensive. The reverse transcription-polymerase chain reaction (RT-PCR) is a rapid, sensitive method for detecting enteroviruses in water. However, environmental samples often contain substances that inhibit PCR amplification of target RNA. Hence the virus must be concentrated by procedures that do not interfere with amplification. This study shows that virus concentration by adsorption onto glass powder or glass wool supports is suitable for detecting viral genomes in treated wastewater by RT semi-nested PCR. No enterovirus genome was detected directly in 25 samples of treated wastewater by RT semi-nested PCR. However, samples concentrated by adsorption onto glass wool or glass powder showed that 48% (glass powder) and 56% (glass wool) contained virus. Secondary concentration by organic flocculation was unsuitable for detecting virus concentrated on glass wool (20% positive samples), but it helped to increase the detection of the genome after concentration on glass powder (72% positive samples).

The surgical anatomy of the fat in the upper eyelid medial compartment

The surgical anatomy of the upper eyelid fat in the medial compartment was investigated in 388 patients and in 12 cadavers. We found two individual fat pads comprising this compartment. The difference among the investigated cases was found to be the extent of their separation. In 16.7 percent of the cadavers' eyelids the fat pads were entirely separated, in 45.8 percent they were separated to about half their length, while in 37.5 percent only the tips were separated. Among the patients in whom only the protruded fat was inspected, 59.8 percent of the fat pads were separated, and in the rest, only the tips were isolated. On histologic examination we could always identify two well-circumscribed fat pads, each surrounded by a fibrocollagenous tissue. At the level of their interconnection, a loose fibroareolar tissue was found. In practice, during blepharoplasty, both fat pads should be addressed in order to achieve the expected results.

Immune globulins are effective in severe pediatric Guillain-Barré syndrome

The effect of high-dose intravenous immune globulins was evaluated in an open prospective multicenter study of 26 children with severe Guillain-Barré syndrome. They presented with mild to moderate flaccid weakness of extremities, with cranial nerve involvement (20) and sensory impairment (22). All children rapidly deteriorated in 2-16 days (mean 6) to become bedridden, and 2 children also developed respiratory failure requiring artificial ventilation (Disability Grading Scale 4-5). Immune globulins were then administered at a total dose of 2 gm/kg, on 2 consecutive days, without adverse effects requiring discontinuation of therapy. Marked and rapid improvement was noted in 25 children, who improved by 1 to 2 Disability Grade Scales < or = 2 weeks after the infusion. Twenty were able to walk independently by 1 week, and 1 could be weaned off a ventilator. Eighteen children recovered by 2 weeks. The rest recuperated in a period of four months, including a child who was artificially ventilated for 4 weeks. The uniform rapid improvement and recovery associated with immune globulins contrasts with the slow recovery course in severe natural cases. We conclude that immune globulins are effective and safe in severe childhood-onset Guillain-Barré syndrome and therefore may serve as the initial treatment of choice.

Effect of heat on the survival of infectious coxsackievirus B3 and its genome in water

The aim of this study was to estimate the resistance of the viral genome of coxsackie B3 to heat (from 25 degrees C to 95 degrees C) with respect to the infectious virus. The results show that viral genomes were much more resistant to heat than infectious virus. The infectious coxsackie B3 was undetectable following incubation at 55 degrees C for 15 min., while the viral genome was still detected after incubation at 95 degrees C for 15 min. The viral genome became undetectable by RT semi-nested PCR after incubation at 95 degrees C for 30 min. We suggest that the rapid loss of infectious ability of the virus after incubation at 55 degrees C may be mostly due to cleavage or conformation changes in the viral capsid without significant destruction of the genome.

[Septic arthritis in an HIV-positive hemophiliac]

Despite the high frequency of bacterial infections in HIV-positive patients, septic arthritis is rare, but it is increasing in HIV-positive hemophiliacs. We describe an HIV-positive male hemophilic, aged 38, with septic arthritis who was treated unsuccessfully with antibiotics for 4 days. Synovial fluid was then aspirated and from the culture grew Salmonella (Group D). He was treated according to the in-vitro sensitivity of the organism and gradually improved. It is important to include septic arthritis in the differential diagnosis of HIV-positive hemophiliacs with arthritis and fever. Synovial fluid should be cultured early in the course of the disease to isolate the pathogen so that antibiotic therapy can be started in accordance with in-vitro sensitivity.

Anti-actin antibodies in sera from patients with autoimmune liver diseases and patients with carcinomas by ELISA

Smooth muscle antibodies (SMA) were initially detected in sera of patients with chronic active hepatitis (CAH). Subsequently, their presence was demonstrated in a wide variety of other diseases. SMA are a mixture of antibodies directed towards different cytoskeletal antigens. Sera with high titers of anti-actin antibodies (AAA), a subgroup of SMA, are most frequently found among patients with autoimmune chronic active hepatitis (CAH) and, to a lesser extent, among patients with primary biliary cirrhosis (PBC) and other diseases. It is therefore established that AAA are a reliable marker to autoimmune CAH. The purpose of this study was to determine the titer of AAA in sera of patients with liver, autoimmune diseases and carcinomas, using the enzyme-linked immunoabsorbent assay (ELISA) method. The results were expressed as the optical density (OD) of the examined sera divided by the OD of a sera from a healthy control (presented as percentages +/- standard deviation). Sera of 33 patients with cirrhosis, nine patients with autoimmune CAH, fifteen patients with non-autoimmune CAH, eight patients with PBC, 30 patients with Sjogren's syndrome, 60 patients with SLE, 142 patients with carcinomas of different kinds, and 34 healthy donors were examined for the presence of AAA by ELISA. Statistically significant (P < 0.003) higher titers of AAA were detected in patients with autoimmune CAH (57 +/- 23%) compared with the control group and to other groups of diseases. AAA titers in non-autoimmune CAH were not significantly higher compared to the control group. High titers of AAA were detected in 67% of the patients with autoimmune CAH, as compared with other diseases in which only up to 13% of the patients exhibited AAA positivity.

CONCLUSION

existence of higher levels of AAA noted in 67% of the patients with autoimmune CAH with regard to other groups of diseases, emphasizes the value of AAA as sensitive and specific markers, capable of characterizing the patients with autoimmune chronic active hepatitis.

Pseudotumor cerebri in systemic lupus erythematosus

OBJECTIVE

To assess the association between pseudotumor cerebri (PC) and systemic lupus erythematosus (SLE), and to seek a pathogenic mechanism that may elucidate the appearance of PC in patients with SLE.

DATA SOURCE

Original English articles having the terms SLE, PC, or benign intracranial hypertension in their titles were identified by Medline search. In addition we report three new patients with this association. STUDY SYNTHESIS: Thirteen articles were found and 21 patients were analyzed.

DATA EXTRACTION

Of the reported 21 patients, 18 were previously reported and 3 new patients with coexisting PC and SLE are described. The clinical characteristics of the patients is presented. Patients with PC and SLE generally had a more severe course of SLE; renal involvement occurred in 79%, massive proteinuria in 47%, and hematologic abnormalities were detected in a third. A hypercoagulable state manifest by either recurrent thromboembolic events or a high anti-cardiolipin antibody titer was detected in 58% of the patients described.

CONCLUSIONS

The association of PC and SLE is probably not coincidental. The high prevalence of serologic or clinical evidence of a hypercoagulable state suggests that microscopical thromboembolic events play a role in the genesis of PC.

[Cerebral infarction in Crohn's disease]

Thromboembolic complications in Crohn's disease are not rare. Most of them are disseminated vascular thrombosis or pulmonary emboli. Cerebral artery thrombosis is a rare complication of Crohn's disease. We describe a 27-year-old woman who had Crohn's disease for 8 years, with exacerbation 3 months before admission. She had bloody diarrhea, abdominal pain, weight loss, weakness, and anemia. Hemoglobin was 6.3 g/dl and she received 3 packed cell transfusions the day of admission. Her hemoglobin level rose to 13 g/dl. 2 days after admission she had generalized tonic-clonic convulsions, followed by hemiparesis. EEG and CT examinations showed right temporal lobe infarction. Many studies report a hypercoagulable state in Crohn's disease, which results in a thromboembolic tendency that is potentially fatal.

Changes in serum, liver and kidneys of cisplatin-treated rats; effects of antioxidants

Cisplatin, a nephrotoxic chemotherapeutic agent, was injected into Sprague Dawley rats, alone or together with cysteine, vitamin E and clonidine. The effects on erythrocyte fragility, serum composition, and kidney and liver enzymes were studied. Cisplatin was administered as two i.p. injections (6 mg/kg body weight) at an interval of 120 hours. The animals were sacrificed 24 hours after the second injection. Erythrocytes were prepared from blood collection with anticoagulant. Serum was prepared from clotted blood, collected without anticoagulant. Kidneys and liver were removed and homogenized, and a supernatant prepared by high speed centrifugation. In cisplatin-treated rats, the serum activities of aspartate aminotransferase, alanine aminotransferase, lactic dehydrogenase and alkaline phosphatase were significantly decreased, whereas the activities of isocitric dehydrogenase and glutathione reductase were increased. Also, concentrations of blood urea nitrogen, creatinine, total lipids and magnesium increased while albumin and glucose decreased. Mean osmotic fragility of erythrocytes from cisplatin-treated rats was decreased, while the haematocrit was increased. In the liver, the only change seen was an increased activity of isocitric dehydrogenase. Much greater changes were found in the kidneys, with increased activity of glucose-6-phosphate dehydrogenase and decreased activities of aspartate and alanine aminotransferases, alkaline phosphatase, malic dehydrogenase, sorbitol dehydrogenase and gamma-glutamyltransferase, as well as a decreased phosphorylation to oxidation ratio in the mitochondria, indicating reduced adenosine triphosphate production. Administration of cysteine and vitamin E together with cisplatin partially reversed the uraemia and many of the biochemical changes induced by cisplatin.(ABSTRACT TRUNCATED AT 250 WORDS)

[Congenital afibrinogenemia with bleeding, bone cysts and antibodies to fibrinogen]

Congenital afibrinogenemia is a rare hereditary disorder which has been described in only 150 families. The main clinical manifestations include spontaneous bleeding into the skin and into the gastrointestinal and genitourinary tracts. Skeletal manifestations are seldom reported. Laboratory findings include coagulation disorders corrected by administration of plasma, cryoprecipitate or fibrinogen. Development of antibodies to treatment with fibrinogen is rare. We report congenital afibrinogenemia in a 25-year-old man with rare complications which included skeletal manifestations such as bone cysts, and the development of antibodies to fibrinogen. Fibrinogen levels could only be maintained in the normal range by continuous infusion of cryoprecipitate, but not by bolus injections.