The role of the capnography head-up tilt test in the diagnosis of syncope in children and adolescents

OBJECTIVES

To evaluate the role of the capnography head-up tilt test (CHUTT) in the diagnosis of syncope in pediatric patients.

METHODS

The CHUTT is a head-up tilt test with concomitant capnometry. Hyperventilation on CHUTT was diagnosed when the patient's end-tidal carbon dioxide pressure (ETPCO2) was </=25 mm Hg. Hyperventilation syncope was diagnosed when three criteria were met: loss of consciousness, ETPCO2 </=25 mm Hg, and no significant drop in blood pressure. The cohort included 65 consecutive children and adolescents (mean age, 14.2 years) who were assessed for syncope by routine investigations and CHUTT.

RESULTS

The cause of the syncope was established in 67% of cases: cardioinhibitory reaction in 17%, vasodepressor in 20%, psychogenic in 22%, and mixed neurally mediated-psychogenic in 8% of the patients. The history indicated a cause of syncope in 40%, the CHUTT in 49%, and a combination of the history and positive CHUTT in 66% of patients. Neither the patients' clinical data nor values of the blood pressure, heart rate, respiratory rate, and ETPCO2 measured during recumbency predicted which patients would manifest hyperventilation or hyperventilation syncope on tilt.

CONCLUSIONS

The CHUTT contributes substantially to the diagnosis of syncope in pediatric patients. The CHUTT advances the understanding of the pathophysiological mechanisms of syncope and enables the physician to reassure the patient regarding the essentially benign nature of the condition. Because it is not possible to predict which patients would develop a hyperventilation syncope on the standard tilt test, the modification of this procedure by measuring the ETPCO2 for the assessment of children with syncope should be considered.

SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions

The Spinal Cord Independence Measure (SCIM) is a new disability scale developed specifically for patients with spinal cord lesions in order to make the functional assessments of patients with paraplegia or tetraplegia more sensitive to changes. The SCIM includes the following areas of function: self-care (subscore (0-20), respiration and sphincter management (0-40) and mobility (0-40). Each area is scored according to its proportional weight in these patients' general activity. The final score ranges from 0 to 100. This study was performed to evaluate the reliability of the SCIM and its sensitivity to functional changes in spinal cord lesion patients compared with the Functional Independence Measure (FIM). Thirty patients were included. Scores were recorded one week after admission and thereafter every month during hospitalization. Each area of function was assessed by a pair of staff members from the relevant discipline. The comparison of scores between each pair of rates revealed a remarkable consistency (r = 0.91-0.99; P < 0.0001; slope approximately 1; constant approximately 0). The total SCIM score (mean = 51, SD = 21) was lower than the total FIM score (mean = 87, SD = 23) owing to the difference in scale range structure and the relatively high cognitive scores of our patients; however, a relationship was noted between the scores of both scales (r = 0.85, P < 0.01). The SCIM was more sensitive than the FIM to changes in function of spinal cord lesion patients: the SCIM detected all the functional changes detected by the FIM total scoring, but the FIM missed 26% of the changes detected by the SCIM total scoring. The mean difference between consecutive scores was higher for the SCIM (P < 0.01). We conclude that the SCIM is a reliable disability scale and is more sensitive to changes in function in spinal cord lesion patients than the FIM. The SCIM when administered by a multidisciplinary team, may be a useful instrument for assessing changes in everyday performance in patients with spinal cord lesion.

Dose-dependent activation of p21ras by IFN-beta

Recent studies have demonstrated that interferon-beta (IFN-beta) activates extracellular regulated kinases (ERKs) in myeloma cells and have revealed a link between ERKs and the Jak/Stat pathway. The upstream components of the IFN-beta pathway involved in activation of ERKs are unknown. As p21ras is often an upstream component of the ERK pathway, we have investigated p21ras activity following IFN-beta treatment of the human myeloma cell line, U266. IFN-beta was found to strongly activate p21ras at relatively low doses and to exert a negative effect at the higher doses normally employed in signaling studies. There was no direct correlation between p21ras and ERK activity, suggesting that p21ras plays an alternate role in the IFN-beta signaling pathway. These results imply a unique integration of p21ras signaling within the milieu of IFN-induced cytoplasmic signaling events.

[Quality of life in younger adults (17-49) after first stroke--a two year follow-up]

To study the effect of stroke on the quality of life in younger adults, 199 patients 17-49 years of age who had sustained a first stroke between 1.11.92 and 31.10.93 were followed up. They were interviewed by telephone at 3, 6, 12 and 24 months after the event. 2 died during the first year of follow-up, and 8 had recurrent strokes. After 2 years, 8 additional patients had died and 4 had sustained recurrent events. Gradual improvement was reported within all age groups and in all areas. During the 3-6 months period, a mean of 4% improvement occurred in functional capability, 15% in social and recreational activity and 8% in return-to-work. The 6-12 month period showed an increase of 3% in improvement in mean functional capability, 10% in social and recreational activity and 2% in return-to-work. 1 year after the stroke 27% remained with moderate to severe disability, but over 86% were functionally independent in their daily living activities. There were no significant changes during the second year of follow-up in these statistics. 67% of those employed prior to their stroke returned to work and approximately 70% reported a return to prestroke social and recreational activity. These results demonstrate that the relatively high recovery rate and functional improvement during a year of follow-up were not accompanied by similar rates of improvement in employment and in social integration. They indicate the need for increased emphasis on long-term psychosocial rehabilitation services within the community.

Diagnosis of fibroadenoma in breast fine needle aspirates devoid of typical stroma

OBJECTIVE

To improve the accuracy of cytologic diagnosis in breast lesion aspirates that are cytologically suggestive of fibroadenoma (FA), exhibiting proliferating epithelial elements and bare nuclei but devoid of the typical stroma.

STUDY DESIGN

A retrospective study was conducted. All available cases (89) that were aspirated and reported as suggestive of FA between 1981 and 1991 and were later biopsied were studied, and various morphologic criteria were analyzed in each smear. A control group consisted of 43 cases that were cytologically diagnosed as FA and confirmed histologically.

RESULTS

Two criteria contributed to the cytologically suggestive diagnosis of FA. The presence of numerous "multilayered" fragments of proliferating glandular epithelium improved the positive predictive value (PPV) for FA on the suggestive smear from 67.4% to 88.3%, and the presence of numerous bare nuclei in the background improved it to 88.9%. The combined presence of both criteria improved the PPV even further, to 91.7%.

CONCLUSION

When an aspirate from a breast lesion is cytologically suggestive of FA despite the absence of the typical stroma, a PPV of 91.7% can be achieved, provided that the epithelial elements include many "multilayered" fragments and that the background consists of numerous bare nuclei.

Effect of ranitidine on the urea breath test: a controlled trial

Because Helicobacter pylori is an acid-sensitive organism, an elevation of the gastric pH by H2 inhibitors might improve the intragastric conditions for the development of this organism. We tested this hypothesis in a prospective and controlled trial including 43 patients positive for H. pylori using the rapid urease test. Twenty-six patients received 150 mg ranitidine twice daily and 17 patients received no treatment. The 14C-urea breath test was performed in both groups at the beginning of the study and 2 weeks later. Radioactive 14C in exhaled carbon dioxide was significantly increased (p = 0.045) in the patients treated with ranitidine, compared with the patients in the control group. Administration of this drug to patients infected with H. pylori is associated with an increase in the bacterial load after 2 weeks of treatment. This phenomenon might be attributed to increased bacterial growth due to the H2 blocker.

Aesthetic results and patient satisfaction with immediate breast reconstruction using tissue expansion: a follow-up study

Immediate breast reconstruction with the tissue expander is now established as an accepted procedure after mastectomy, and large series have been published concerning the technique and its complications. Unfortunately, only scarce information is available regarding the long-term aesthetic results and patient satisfaction achieved by immediate reconstruction using tissue expansion. In this study, we reviewed 52 patients who had undergone immediate breast reconstruction using the tissue expander with a follow-up of at least 1 year after completion of the reconstruction. We developed an objective assessment of patient satisfaction, aesthetic results, and the factors affecting them. The results show remarkable concordance of assessment by patient, surgeon, and independent observer: All gave good scores for aesthetic appearance (6.4 to 7.4 on a scale of 1 to 10). A total of 92.3 percent of patients rated their satisfaction as good to excellent. Symmetry was the main parameter influencing the patients' score, while the surgeon's score also was affected by the quality of the inframammary fold and capsular contracture. Breast size, chemotherapy, complications, time interval, and additional procedures had no relation to either scoring or patient satisfaction.

The role of external sphincterotomy for patients with a spinal cord lesion

For the last three decades external sphincterotomy has been well accepted as a treatment for bladder outlet obstruction in patients with a spinal cord lesions. Recently, however, its value has been brought into question. To assess the current place of this procedure in the treatment of the neuropathic bladder of spinal origin, we studied the outcomes of sphincterotomy in 32 patients. Post-voiding residual urine volume decreased after surgery in 27 patients (84%), considerably in 22 (69%) of them. Clinical infection resolved in 14 out of 19 patients (74%), hydronephrosis disappeared in two out of three (66%), and vesicourethral reflux improved in three out of five (60%) and was cured in two (40%). Six of the patients (19%) were freed from catheterization, but two patients (6%) lost partial continence. Sphincterotomy is an important tool in the treatment of spinal patients with bladder outlet obstruction and should be considered when the proper indications exist.

Circulating pemphigus IgG in families of patients with pemphigus: comparison of indirect immunofluorescence, direct immunofluorescence, and immunoblotting

BACKGROUND

Patients with pemphigus vulgaris (PV) are genetically linked to two alleles of the HLA subgroup, and circulating antibodies were found in first-degree relatives of these patients, thus showing genetic predisposition.

OBJECTIVE

Our purpose was to determine the occurrence of circulating true PV-IgG in patients' relatives.

METHODS

Circulating PV-IgG was determined in 21 first-degree relatives of 12 patients with PV by indirect immunofluorescence on monkey esophagus, carcinoma A431 cultures, and Western immunoblotting. Direct immunofluorescence was performed on skin biopsy specimens of 20 relatives.

RESULTS

Circulating PV-IgG was detected in 15 relatives (71%) by all methods tested. Good correlation was found between immunoblot reactivity and immunofluorescence. Of the 15 "positive" relatives, only five showed fixation of IgG to epidermal cells in vivo.

CONCLUSION

The permeability of the epidermis or epidermal cell reactivity in vivo probably controls the expression of disease in patients' relatives.

Growth of the fetal nose width and nostril distance in normal pregnancies

The study was planned to obtain the dimensions of the fetal nose width and nostril distance during normal pregnancy as a basis for further studies and for identification of deviations in growth. The study group included 302 healthy pregnant women at 14-40 weeks' gestation. Routine biometric measurements were obtained from all the participants, including biparietal diameter, head and abdominal circumferences, measurements of the long bones and dimensions of the fetal nose width and nostril distance. The nose width and nostril distance were also calculated for each gestational age. A linear growth relationship was observed between nose width and gestational age (r = 0.88; p < 0.0001; y = 0.27 + 0.57 x gestational age), biparietal diameter (r = 0.92; p < 0.0001; y = 0.41 + 0.23 x biparietal diameter), head circumference (r = 0.91; p < 0.00001; y = 0.85 + 0.63 x head circumference), femoral length (r = 0.91; p < 0.0001; y = 3.18 + 0.26 x femoral length) and humeral length (r = 0.73; p < 0.0001; y = 1.94 + 0.11 humeral length). A linear growth function was also observed between nostril distance and gestational age (r = 0.54; p < 0.00001; y = 2.77 + 0.15 x gestational age), biparietal diameter (r = 0.71; p < 0.00001; y = 1.83 + 0.08 x biparietal diameter), head circumference (r = 0.70; p < 0.00001; y = 1.99 + 0.2 x head circumference), femoral length (r = 0.75; p < 0.00001; y = 2.49 + 0.09 x femoral length) and humeral length (r = 0.91; p < 0.00001; y = 1.89 + 0.32 x humeral length). A linear growth relationship was found between nose width and nostril distance (r = 0.71; p < 0.00001; y = 1.81 + 0.31 x nose width). These results provide normative data of the fetal nose width and nostril distance in various dimensions and across gestational age. In addition, the data offer the potential for prenatal diagnosis of nose and nostril abnormalities.

The adolescent parturient: a study of an Israeli population

The aim of this study was to describe the frequency and characteristics of adolescent deliveries and to identify issues that might require intervention, in Haifa District, which is the third largest in Israel. The specific objectives were to assess the prevalence of 15-19-year-old parturients in the district, to characterize the younger (15-17-year) age group for demographics and educational status as well as for pregnancy and delivery progress, to describe the newborn babies of these mothers, and to compare the Jewish and Arabic subpopulations within the younger group for these parameters.

Inhibition of T lymphocyte activation by cAMP is associated with down-regulation of two parallel mitogen-activated protein kinase pathways, the extracellular signal-related kinase and c-Jun N-terminal kinase

The induction of T cell proliferation requires signals from the TCR and a co-receptor molecule, such as CD28, that activate parallel and partially cross-reactive signaling pathways. These pathways are disrupted by agonists that utilize adenylate cyclase and cAMP-dependent protein kinase A (PKA). We found that the adenylate cyclase activator, forskolin, inhibits anti-CD3-induced shift in Lck electrophoretic mobility, suggesting an intervention at the TCR-coupled phosphoinositide turnover that precedes the activation of PKC. The shift of Lck following direct PKC activation by 12-O-tetradecanoyl phorbol 13-acetate, which bypasses early receptor-triggered biochemical events, is insensitive to forskolin. Nevertheless, forskolin also inhibits PKC downstream events, such as c-jun expression, which is critical for the activation process of T cells. To further analyze potential cross points between positively and negatively regulating signaling pathways in T cells, we tested the effects of activators of the adenylate cyclase or PKA on two parallel mitogen-activated protein kinase signaling pathways mediated by extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase. Using a PKC-specific inhibitor, GF109203X, or PKC-depleted T cells, we found that a large part of the anti-CD3-induced ERK activation is PKC dependent. Both PKC-dependent and -independent activation of ERK were sensitive to inhibition by forskolin or a cell-permeable cAMP analogue, dbcAMP. Furthermore, the effect of 12-O-tetradecanoyl phorbol 13-acetate and ionomycin, which synergized to fully activate c-Jun N-terminal kinase, was also sensitive to inhibition by forskolin. Our results suggest that PKA inhibits T cell activation by interfering with multiple events along the two signaling pathways operating downstream of the TCR and the CD28 co-receptor molecules.

Inhibition of T lymphocyte activation by cAMP is associated with down-regulation of two parallel mitogen-activated protein kinase pathways, the extracellular signal-related kinase and c-Jun N-terminal kinase

The induction of T cell proliferation requires signals from the TCR and a co-receptor molecule, such as CD28, that activate parallel and partially cross-reactive signaling pathways. These pathways are disrupted by agonists that utilize adenylate cyclase and cAMP-dependent protein kinase A (PKA). We found that the adenylate cyclase activator, forskolin, inhibits anti-CD3-induced shift in Lck electrophoretic mobility, suggesting an intervention at the TCR-coupled phosphoinositide turnover that precedes the activation of PKC. The shift of Lck following direct PKC activation by 12-O-tetradecanoyl phorbol 13-acetate, which bypasses early receptor-triggered biochemical events, is insensitive to forskolin. Nevertheless, forskolin also inhibits PKC downstream events, such as c-jun expression, which is critical for the activation process of T cells. To further analyze potential cross points between positively and negatively regulating signaling pathways in T cells, we tested the effects of activators of the adenylate cyclase or PKA on two parallel mitogen-activated protein kinase signaling pathways mediated by extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase. Using a PKC-specific inhibitor, GF109203X, or PKC-depleted T cells, we found that a large part of the anti-CD3-induced ERK activation is PKC dependent. Both PKC-dependent and -independent activation of ERK were sensitive to inhibition by forskolin or a cell-permeable cAMP analogue, dbcAMP. Furthermore, the effect of 12-O-tetradecanoyl phorbol 13-acetate and ionomycin, which synergized to fully activate c-Jun N-terminal kinase, was also sensitive to inhibition by forskolin. Our results suggest that PKA inhibits T cell activation by interfering with multiple events along the two signaling pathways operating downstream of the TCR and the CD28 co-receptor molecules.

Presence of family member during upper endoscopy. What do patients and escorts think?

We evaluated what effect an escort present during upper endoscopy had on the attitude and anxiety level of patients and on the escorts. The study consisted of 206 patients (ages 15-85, 47% male) and their escorts. Both patients and escorts were interviewed before the procedure. Escorts were then randomly divided into two groups-on-the-spot escorts, who present throughout the procedure, as opposed to waiting-room escorts. Both groups were reinterviewed following the procedure. Before the procedure, 80% of the patients understood the nature of endoscopy. Thirteen percent believed the procedure to be dangerous, and only 33% were totally worry-free. Fifty percent preferred to be escorted during the procedure, while 17% refused. Following the procedure, 89% of the patients who were escorted in the endoscopy room expressed satisfaction. Fifty-two percent of the patients found the procedure to be mild, with a higher proportion among escorted patients. Among the escorts, 63% felt that their close presence had lessened their own fears and anxiety regarding the procedure, and 72% believed their presence to have been supportive to the patient. Having an escort present throughout endoscopy appears to be a promising approach.

Stroke in the young in Israel. Incidence and outcomes

BACKGROUND AND PURPOSE

Data on stroke in the young in Israel are fragmentary. To obtain an overall perspective and to assess the nature and magnitude of the problem, a study was conducted on stroke occurrence in the young population during 1 year. Incidence and outcomes are reported in this communication.

METHODS

We conducted a prospective ascertainment of first stroke in all permanent residents of Israel aged 17 to 49 years who were referred to all acute-care hospitals in the country or died before reaching them.

RESULTS

We identified 253 first stroke victims in the studied population; 62.8% were male. The age- and sex-adjusted incidence rate for all types of stroke was 10.36/100 000 per year (males, 13.00; females, 7.71). The majority of strokes (80.6%) were cerebral infarctions, with 9.9% intracerebral hemorrhages, 7.9% subarachnoid hemorrhages, and 1.6% strokes of unspecified type. The case-fatality rate for all types of stroke was 9.9% (mortality within the first 4 weeks after the event, on average 6 days). The survival rate was 95% for cerebral infarctions, 64% for intracerebral hemorrhages, and 80% for subarachnoid hemorrhages; 86.7% of all survivors remained with an impairment resulting in a disability.

CONCLUSIONS

Incidence rates were similar to those reported from developed Western countries. The case-fatality rate of 9.9% and the considerable percentage of survivors with a disability in a population at the beginning of their family, professional, and social lives indicate the magnitude of the problem.

Decreased ferritin levels, despite iron supplementation, during erythropoietin therapy in anaemia of prematurity

Erythropoietin (rHuEPO) therapy has been shown to be beneficial in preventing and treating anaemia of prematurity and to decrease the need for blood transfusions. There is, however, only scanty data on the effect of rHuEPO therapy on iron metabolism. We studied 29 preterm infants (age 34 +/- 14 days) who were randomly assigned to receive either rHuEPO 900 U kg-1 week-1 with 6 mg kg-1 day-1 of iron for 4 weeks (n = 15) or no therapy. The following parameters were evaluated and compared between and within groups at the beginning, during and at the end of the study: Haematocrit (SI), reticulocytes (10(9) micrograms l-1), serum ferritin (microgram 1-1) and iron (mumol l-1). The results were as follows. At the baseline, erythropoietin levels were similar in both groups: 7.2 +/- 5.6 versus 6.2 +/- 3.2 mU ml-1 (NS). In the treated infants the haematocrit remained stable during the study and was significantly higher than in the control group by the end of the study: 0.34 +/- 0.03 versus 0.28 +/- 0.05 (p = 0.001). rHuEPO therapy increased the reticulocyte count from 130 +/- 70 to 430 +/- 200 (p = 0.0002). However, rHuEPO therapy depleted both serum ferritin and iron levels from 321 +/- 191 to 76 +/- 58 micrograms l-1 (p = 0.04) and from 18 +/- 5 to 13 +/- 4 mumol l-1 (p = 0.03), respectively. We conclude that rHuEPO therapy prevented anaemia and its sequelae; however, serum ferritin and iron levels were depleted. We suggest that the effect of rHuEPO may be further increased by higher iron supplementation.

[Incidence, risk factors and causes of stroke in young adults]

A 1-year, nation-wide study was conducted to determine the incidence, risk factors and causes of stroke in young adults. Permanent residents of Israel of both genders, aged 17-49 years, who were referred to 23 general hospitals with a first, acute stroke from 1 Nov. 1992 to 31 Oct. 1993, were studied. Briefed investigators administered a prospective questionnaire pertaining to demographic and socioeconomic variables; past, present and family histories; and condition on admission and discharge. 253 subjects, 17-49 years of age, of whom 62.8% were men, had a first stroke during the year. The incidence was 10.3/100,000/year, increasing with age. 80.6% of strokes were due to infarctions, 9.9% intracerebral hemorrhages, 7.9% subarachnoid hemorrhages, and 1.6% were of undetermined type. There was no seasonal variation in incidence; 45.6% occurred in the morning. The main risk factors were smoking (53.6%), hypertension (43.4%), hyperlipidemia (22%) and diabetes (21%). Atherosclerosis was the main cause of the strokes (52%). In 3.5% there was no residual damage, 10.3% were left with minimal damage, 40.3% remained with minor disability, 19% with moderate disability, 17.4% with severe disability and 9.9% died. The data on incidence concur with those published from western Europe. However, the data on risk factors differ from those of young adults and are identical with those of the older population. Although these risk factors can be modified, preventive measures were insufficiently used. More comprehensive diagnosis is needed to determine stroke etiology in each patient and establishing a national stroke registry is important for planning and improving services.

Observer variation in the interpretation of bone scintigraphy

To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent k values were obtained for inter- and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, k values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.

Topical treatment with 1% sodium cromoglycate in pyoderma gangrenosum

BACKGROUND

Pyoderma gangrenosum is an uncommon skin disease usually treated with systemic drugs, most frequently corticosteroids. Isolated topical treatment is usually considered unsatisfactory.

OBJECTIVE

To evaluate the effect of topical 1% sodium cromoglycate solution on pyoderma gangrenosum in 5 patients 25-30 years of age.

METHODS

5 patients, including 2 under systemic steroid treatment, hospitalized in our department from 1992 to 1993 because of pyoderma gangrenosum, were treated with topical 1% sodium cromoglycate solution. Systemic corticosteroids were further added in 2 patients whose initial improvement was inadequate.

RESULTS

Initial improvement was noted in all 5 patients after 3-7 days of sodium cromoglycate treatment. Complete healing of the ulcers occurred within 5-8 weeks.

CONCLUSIONS

Topical treatment with sodium cromoglycate can be effective as adjunctive or sole treatment in pyoderma gangrenosum.

Seasonal fluctuations in acute gastrointestinal bleeding

We investigated the seasonal variability of upper gastrointestinal bleeding retrospectively during 1988-92 in Haifa, Israel, a city with a subtropical climate. Four hundred and thirty three patients were included in the study: duodenal ulcer, 202; hemorrhagic gastritis 108; gastric ulcer 101; duodenal ulcer and hemorrhagic gastritis 12; and duodenal ulcer and gastric ulcer, 10. The highest incidence of bleeding was observed during winter (31.7%) and spring (28.3%), progressively diminishing throughout summer (18.5%) and fall (21.5%) (p < 0.0001). Both females and males showed this significant seasonal variation (p < 0.025 and p < 0.005, respectively). As a group, patients over 57 years of age had the highest incidence of bleeding during winter and spring (p < 0.005). Interestingly, the ingestion of NSAID had no influence in the increased seasonal bleeding. Duodenal ulcer (p < 0.01) and hemorrhagic gastritis (p < 0.05) showed a significant seasonal variation while gastric ulcer did not. Although there are several reports in the literature concerning seasonal fluctuations in duodenal and gastric ulcers, no such studies have hitherto been published on hemorrhagic gastritis.

Commercial dialysate inhibits TNF alpha mRNA expression and NF-kappa B DNA-binding activity in LPS-stimulated macrophages

Continuous ambulatory peritoneal dialysis is known to interfere with the normal inflammatory responses of macrophages in the peritoneal cavity. Commercial peritoneal dialysis solution (CDS) has been shown to inhibit tumor necrosis factor alpha (TNF alpha) release from LPS stimulated peritoneal macrophages. To further dissect the mechanism of this inhibition, we used human blood-derived macrophages or the murine macrophage cell line, P388D1, that were stimulated with LPS after pretreatment with CDS, and tested TNF alpha mRNA levels by Northern hybridization or reverse transcriptase polymerase chain reaction. Time course studies demonstrated that CDS lowered TNF alpha mRNA levels within 15 minutes of pretreatment of cells. In addition, the CDS inhibited DNA binding activity of NF-kappa B that is probably involved in regulation of LPS-mediated transcriptional activation of the TNF alpha gene. Inhibition was dependent on both the low pH and the lactate in the CDS, but was independent of the osmolarity or glucose concentration. The rate of catabolism of TNF alpha mRNA was not affected by CDS as demonstrated by actinomycin D chase experiments. Thus, impairment of LPS-stimulated macrophage function by CDS is associated with low TNF alpha mRNA which may be the result of the low activity of NF-kappa B. Since NF-kappa B is involved in transcription regulation of a large number of "early activation" genes, CDS may interfere with the production of additional immunomodulatory proteins that are encoded by genes possessing NF-kappa B site(s) in their promoter region.

[Prevalence of diabetes mellitus and glucose intolerance in adult Ethiopian immigrants]

339 adult immigrants from Ethiopia were surveyed 1 year after arrival. They were screened for diabetes mellitus and impaired glucose tolerance by measurement of serum HgbA1C levels. The levels were higher than normal in 35 subjects (10.3%), and were significantly higher in immigrants consuming the Israeli diet, which is richer in proteins and carbohydrates, than in those on the Ethiopian diet. Oral glucose load was abnormal in 7 subjects. 3 had overt diabetes mellitus with absent serum insulin response to glucose load. 4 had glucose intolerance with normal insulin secretion. However, clinical appearance of diabetes was incidental and diabetes ketoacidosis was not detected. The overall prevalence of diabetes mellitus and glucose intolerance in this ethnic group (2.1%) is similar to that in the general population of Israel. Longitudinal studies would indicate the exact prevalence and type of diabetes mellitus among the Ethiopian immigrants.

Goiter prevalence in children immigrating from an endemic goiter area in Ethiopia to Israel

A survey study was performed to assess the prevalence of goiter and thyroid dysfunction in a population of 534 Ethiopian children, one year after arrival in Israel. The overall prevalence of goiter was 43.6%. Children in the age group 1-2 years had the lowest prevalence of goiter (6.7%). A progressive increase in goiter prevalence and size with age was observed, with peak occurrence around puberty for both boys (56.7%) and girls (72.2%). Serum FT4 levels were elevated in 4 children; elevated serum TSH levels (above 4.5 mIU/l) were found in 11 children, all of them had normal FT4 levels. Thus the prevalence of hypothyroidism and hyperthyroidism was 2% and 0.8%, respectively, with an even distribution across the various age groups. All the children were clinically normal. The high prevalence of goiter in this group of Ethiopian children with the low frequency of hypothyroidism may be attributed to the combined effects of food goitrogens and iodine deficiency prevailing in Ethiopia. The standard Israeli diet seems to be adequate in respect to iodine requirements, and no iodine enrichment is needed for children immigrating from Ethiopia.