Mitral valve prolapse in hyperthyroidism of two different origins.

The prevalence of mitral valve prolapse was investigated in 126 patients with hyperthyroidism due to Graves' disease or toxic nodular goitre and that of hyperthyroidism in 64 patients with mitral valve prolapse. One hundred and eleven asymptomatic healthy subjects comprised a control group. The patients with hyperthyroidism were divided into those with Graves' disease and those with toxic nodular goitre. Of the group as whole, 12 (9.5%) patients had mitral valve prolapse compared with six (5.4%) in the control group, but the difference was not statistically significant. The prevalence of mitral valve prolapse in the patients with toxic goitre was also not significantly different from that in the controls. When the prevalence in the group with Graves' disease was compared with that in the control group (16.3% vs 5.4%) the difference was significant. Only one patient with mitral valve prolapse had hyperthyroidism.     

Transient postpartum diabetes insipidus

Diabetes insipidus may first present before, during, or immediately after pregnancy. The characteristics of two unusual cases of transient postpartum diabetes insipidus are described and discussed.     

Pregnancy outcome in women with heart disease undergoing induction of labour

OBJECTIVE: To examine the safety and outcome of induction of labour in women with heart disease. DESIGN: Prospective single-centre comparative study. SETTING: Major university-based medical centre. POPULATION/SAMPLE: One hundred and twenty-one pregnant women with heart disease. METHODS: The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. MAIN OUTCOME MEASURES: Pregnancy outcome. RESULTS: Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. CONCLUSION: Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour.     

Glomerular deposition of renal tubular epithelial antigen in patients with systemic lupus erythematosus: its possible role in lupus nephritis

Fifty-three renal specimens from 48 patients with SLE were examined for the presence of RTE in the glomeruli. Glomerular RTE, presumably in immune complex form was detected in 60% of the tissues. The deposition of these complexes was related to the severity of histologic changes and activity of SLE. In addition, glomerular localization of RTE was associated with decreased renal function and increased proteinuria. The association between the presence of glomerular RTE antigen, the severity of renal histologic changes and the decreased renal function suggested a possible role for this antigen in the pathogenesis of lupus nephritis.     

From the Cover: Earliest economic exploitation of chicken outside East Asia: Evidence from the Hellenistic Southern Levant

Chicken (Gallus gallus domesticus) is today one of the most widespread domesticated species and is a main source of protein in the human diet. However, for thousands of years exploitation of chickens was confined to symbolic and social domains such as cockfighting. The question of when and where chickens were first used for economic purposes remains unresolved. The results of our faunal analysis demonstrate that the Hellenistic (fourth–second centuries B.C.E.) site of Maresha, Israel, is the earliest site known today where economic exploitation of chickens was widely practiced. We base our claim on the exceptionally high frequency of chicken bones at that site, the majority of which belong to adult individuals, and on the observed 2:1 ratio of female to male bones. These results are supported further by an extensive survey of faunal remains from 234 sites in the Southern Levant, spanning more than three millennia, which shows a sharp increase in the frequency of chicken during the Hellenistic period. We further argue that the earliest secure evidence for economic exploitation of chickens in Europe dates to the first century B.C.E. and therefore is predated by the finds in the Southern Levant by at least a century. We suggest that the gradual acclimatization of chickens in the Southern Levant and its gradual integration into the local economy, the latter fully accomplished in the Hellenistic period, was a crucial step in the adoption of this species in European husbandry some 100 y later.In the modern world, the chicken (Gallus gallus domesticus) is one of the most widespread livestock species and is a major source of animal protein in the human diet. The ancestor of the domestic chicken is the red jungle fowl (Gallus gallus), originating in Southeast Asia, with possible genetic contributions from closely related species through hybridization (1–5). Intensive hybridization between the modern chicken and its wild ancestor caused a loss of the wild progenitor genes (6, 7). Consequently, recent studies usually have focused either on the genetics of the chicken progenitor (8–12) or on zooarchaeological evidence for the domestication of chickens (13–15).The dispersal trajectory of chickens to West Asia, to the Mediterranean, and to Europe following its initial domestication in Southeast Asia remains largely unknown. Moreover, there are only very partial data, and thus there is great uncertainty regarding the place and time of the earliest economic exploitation of chickens: When and where did chickens move from being an exotic species, used only sporadically for symbolic and ritual purposes, to an important livestock species in the Mediterranean and European economies (16, 17)? Our study of chicken remains from the Southern Levant (Israel, the Palestinian Authority, and Jordan) and particularly from the Hellenistic site of Maresha in Southern Israel sheds new light on these issues.We define three main phases in the cultural history of chicken use, based on archaeological, historical, and iconographic evidence (Fig. 1). The early phase (Fig. 1, phase A) may have already begun around the sixth millennium B.C.E. when the chicken was initially domesticated during several independent domestication events in Southeast Asia and China (1, 2, 4, 11, 12). On the Indian subcontinent, which also constitutes a part of the natural dispersal range of the jungle fowl, chicken remains were recorded at a few second millennium B.C.E. sites, and it is commonly assumed that domestication occurred there independently (1, 14, 15, 18, 19). The second phase took place in the third–second millennia B.C.E. and includes the dispersal of the chicken out of its natural distribution range to West Asia (Fig. 1, phase B). The earliest chicken remains in the Near East were retrieved in Iran, Anatolia, and Syria and dated to the third millennium B.C.E. or slightly earlier (20). In Egypt, the oldest known chicken remains are possibly even earlier (16). At this early phase, chicken remains in archaeological sites are very sparse and often are not associated with domestic contexts. Historical and iconographic records demonstrate an acquaintance with the chicken from the mid-second millennium B.C.E. in Egypt, Mesopotamia, and the Levant (21). All these sources relate to chickens (almost exclusively cocks) as an exotic bird, used inter alia for cockfighting and displayed as exotica in royal zoos. The third phase includes its introduction to Europe (Fig. 1, phase C1) and the intensification of its use mainly on this continent (Fig. 1, phase C2).Open in a separate windowFig. 1.The dispersal of chickens in the Old World: the area marked “A” is the geographical range of the jungle fowl in South Asia and its initial domestication, which already may have begun around the sixth millennium B.C.E. in Southeast Asia and possibly in China; The area marked “B” maps the dispersal of chickens to West Asia during the third and second millennia B.C.E. C1 represents the first wave of chicken dispersal into Europe: introduction to Europe during the eighth century B.C.E. (chicken remains have low representation in sites). C2 represents the second wave of chicken dispersal into Europe and other regions from the first century B.C.E. (chicken remains have higher representation in sites). The location of Maresha is marked in the enlarged map (Inset).Archaeologically, chicken remains are first observed in Europe only in late ninth and eighth century B.C.E. contexts. The introduction of chickens to this region usually is attributed to the Phoenicians who brought chickens from their homeland to their colonies in the West (17, 22). This hypothesis is based on the fact that the earliest chicken remains in Europe were retrieved from Phoenician sites, mostly (although not only) in Iberia (23–25). The oldest reliable dated remains of chickens from central Europe (in the Czech Republic) are from the eighth century B.C.E. (26). The continued presence of chickens has been confirmed in Iberia (27, 28), as well as in southern France and Greece (24, 29), during the second half of the first millennium B.C.E. (Fig. 1, phase C1). However, a survey of the zooarchaeological literature of Europe demonstrates that before the first century B.C.E. the proportion of chicken remains in archaeological sites was extremely low and hardly ever exceeded 3% of the total faunal remains (25, 30, 31).The historical evidence also marks the eighth century B.C.E. (or even slightly later) as the arrival date of chickens in Europe. The arrival of chickens in Greece likely postdates Homer (around the eighth century B.C.E.), because the Greek poet does not mention this bird, but chickens are mentioned by Theognis of Megara in the sixth century (32). From the seventh century B.C.E., cocks are depicted on Greek coins and vases (28). In the fifth century B.C.E., the Greek playwright Aristophanes refers to the chicken as the “Persian bird” or “Median bird” (33), possibly indicating that in this period chickens were imported to Greece from Persia (14, 34). By the third century cocks became portrayed more frequently in Egypt (14, 22, 35 and references therein), but in Ptolemaic papyri chickens are hardly mentioned compared with other domesticated species (36). The symbolic role of cocks is well demonstrated by the Roman writer Cicero in his De Divinatione (37), where he mentions that cocks accompanied the Roman armies in 249 B.C.E. and that their behavior was observed carefully before battle as a sign of defeat or victory. Finally, fighting cocks are mentioned by Roman writers such as Varro (38) and Columella (39) (see also refs. 14 and 17).Returning to faunal data, from the first century B.C.E., more sites with chicken remains are known in Europe, and the proportions of chickens at these sites are higher (Fig. 1, phase C2). This increase is apparent in Roman sites in Italy (40) and later in Southern Britain (13) and Sweden (41, 42). Significant proportions of chicken remains are observed in some first century B.C.E. locations in the Near East, such as in Sagalassos in Anatolia (43, 44) and Petra in Jordan (45, 46), and at Berenike (47) and Mons Claudianus (48) in Egypt. Indeed, the relative number of chicken remains in Berenike during Roman times is almost threefold that of the Ptolemaic period (49).Unlike chicken bones, chicken egg shells often are overlooked during excavation (50). The first archaeological evidence for chicken eggs in the Mediterranean is from the first century B.C.E. This evidence includes some examples from Mons Claudianus and a high percentage of medullary bones from Berenike, indicative of females during laying time (47).Although the faunal evidence points to the first century B.C.E. as a turning point in patterns of chicken exploitation in the Mediterranean, the historical and iconographic records imply a slightly earlier date for its economic utilization. For example, a Roman law in the Lex Faunia (161 B.C.E.) banned the consumption of more than a single chicken per meal. Other remarkable testimonies for the integration of the chicken into European livestock in the first century B.C.E. are provided by the Greek historian Diodorus Siculus, who described the sophisticated technique of artificial incubation of chicken eggs in Ptolemaic Egypt (51), and by the Roman historian Varro, who offered advice on how to treat hens during laying time (38). Subsequently, in the first century C.E. the Roman writer Columella and the Roman culinary Apicius mention chicken eggs among the ingredients in culinary recipes (39, 52).We propose that the intensification in chicken exploitation in Europe during phase C2, as reflected by the archaeological and historical records, is related to our new data regarding chicken husbandry in the Southern Levant. The main new data we present here are from the site of Maresha, a national park situated in the Judean foothills in Southern Israel (Fig. 1 and Fig. S1) and dated to the Hellenistic period (fourth–second centuries B.C.E.). Located on an important trading route, Maresha flourished as a leading city of the region of Idumea, and its population comprised a complex ethnic mosaic (53). The town was in ruins by the late second century B.C.E. and was never resettled. In Hellenistic Maresha we note that, in addition to the symbolic cock painted in the so-called “Sidonian” tomb there (54), unisex chicken figurines are more common than any other animal figurines except for riders on horses (55, 56).Open in a separate windowFig. S1.(A) Plan of Maresha in the Hellenistic period with analyzed subterranean complexes 1, 169, 89, 147, and 57 indicated. Image courtesy of ref. 76. (B) Examples of subterranean complexes at Maresha. (Upper) Olive press, subterranean complex no. 44 in Maresha. (Lower) Columbarium, subterranean complex no. 30 in Maresha. Image courtesy of Boaz Zissu.The unprecedented amount of chicken remains revealed at Maresha, far outside the original distribution of the domestic fowl, coupled with the clear chronology of the findings and the excellent preservation of the chicken bones, render Hellenistic Maresha a key site for understanding the new role of the chicken in the Mediterranean during this period. The study of the faunal evidence at Maresha is followed by a comparative chronological and regional study, based on the frequency of chicken remains as presented in 234 faunal reports from the Southern Levant, spanning all periods until early modern times. This study provides diachronic data on the process of introduction and subsequent widespread adoption of the chicken in Levantine economies. We offer suggestions based on these data regarding the time and mode of expansion of chickens from Southwest Asia to Europe and throughout the Mediterranean.     

Examining hypnosis legislation: a survey of the practice in Israel

Hypnosis as a therapeutic technique bears potential risks when carried out inexpertly. Because of this, Israel was the first to legislate hypnosis. This study examines the current state of clinical hypnosis practice in Israel. A questionnaire was sent to 470 licensed hypnotists and 1250 unlicensed professionals; 478 (25.7%) of the 1720 potential respondents returned the questionnaires. Of these, 249 (51.8%) were licensed hypnotists, and 232 (48.2%) were unlicensed. Of the unlicensed professionals, 45% reported practicing hypnosis; 50% of them practice hypnosis with adolescents and 41.2% with children. Many of them practice hypnosis in public clinics (71.6%). Of the licensed professionals, 94.4% reported practicing hypnosis in the course of their clinical work. The authors conclude that great number of unlicensed hypnotists carry on clinical practice of hypnosis and suggest steps to increase the efficiency of the law as part of a regulatory system.     

Pediatric renal transplantation under tacrolimus-based immunosuppression

BACKGROUND: Tacrolimus has been used as a primary immunosuppressive agent in adult and pediatric renal transplant recipients, with reasonable outcomes. Methods. Between December 14, 1989 and December 31, 1996, 82 pediatric renal transplantations alone were performed under tacrolimus-based immunosuppression without induction anti-lymphocyte antibody therapy. Patients undergoing concomitant or prior liver and/or intestinal transplantation were not included in the analysis. The mean recipient age was 10.6+/-5.2 years (range: 0.7-17.9). Eighteen (22%) cases were repeat transplantations, and 6 (7%) were in patients with panel-reactive antibody levels over 40%. Thirty-four (41%) cases were with living donors, and 48 (59%) were with cadaveric donors. The mean donor age was 27.3+/-14.6 years (range: 0.7-50), and the mean cold ischemia time in the cadaveric cases was 26.5+/-8.8 hr. The mean number of HLA matches and mismatches was 2.8+/-1.2 and 2.9+/-1.3; there were five (6%) O-Ag mismatches. The mean follow-up was 4.0+/-0.2 years. RESULTS: The 1- and 4-year actuarial patient survival was 99% and 94%. The 1- and 4-year actuarial graft survival was 98% and 84%. The mean serum creatinine was 1.1+/-0.5 mg/dl, and the corresponding calculated creatinine clearance was 88+/-25 ml/min/1.73 m2. A total of 66% of successfully transplanted patients were withdrawn from prednisone. In children who were withdrawn from steroids, the mean standard deviation height scores (Z-score) at the time of transplantation and at 1 and 4 years were -2.3+/-2.0, -1.7+/-1.0, and +0.36+/-1.5. Eighty-six percent of successfully transplanted patients were not taking anti-hypertensive medications. The incidence of acute rejection was 44%; between December 1989 and December 1993, it was 63%, and between January 1994 and December 1996, it was 23% (P=0.0003). The incidence of steroid-resistant rejection was 5%. The incidence of delayed graft function was 5%, and 2% of patients required dialysis within 1 week of transplantation. The incidence of cytomegalovirus was 13%; between December 1989 and December 1992, it was 17%, and between January 1993 and December 1996, it was 12%. The incidence of early Epstein-Barr virus-related posttransplant lymphoproliferative disorder (PTLD) was 9%; between December 1989 and December 1992, it was 17%, and between January 1993 and December 1996, it was 4%. All of the early PTLD cases were treated successfully with temporary cessation of immunosuppression and institution of antiviral therapy, without patient or graft loss. CONCLUSIONS: These data demonstrate the short- and medium-term efficacy of tacrolimus-based immunosuppression in pediatric renal transplant recipients, with reasonable patient and graft survival, routine achievement of steroid and anti-hypertensive medication withdrawal, gratifying increases in growth, and, with further experience, a decreasing incidence of both rejection and PTLD.     

Effectiveness of combined interleukin 2 and B7.1 vaccination strategy is dependent on the sequence and order: a liposome-mediated gene therapy treatment for bladder cancer.

We have developed a novel liposome-mediated immunogene therapy using interleukin 2 (IL-2) and B7.1 in a murine bladder cancer model. A carcinogen-induced murine bladder cancer cell line, MBT-2, was transfected with cationic liposome 1,2-dimyristyloxypropyl-3-dimethyl-hydroxyethyl ammonium bromide/dioleolylphosphatidylethanolamine and IL-2 plasmid. The optimized transfection condition generated IL-2 levels of 245-305 ng/10(6) cells/24 h, 100-fold higher than the levels seen with retrovirus transfection. Ninety percent of the peak level of IL-2 production was maintained for up to 11 days after transfection. Animal studies were conducted in C3H/HeJ female mice with 2 x 10(4) MBT-2 cells implanted orthotopically on day 0. Multiple vaccination schedules were performed with i.p. injection of 5 x 10(6) IL-2 and/or B7.1 gene-modified cell preparations. The greatest impact on survival was observed with the day 5, 10, and 15 regimen. Control animals receiving retrovirally gene-modified MBT-2/IL-2 cell preparations had a median survival of 29 days. Animals receiving the IL-2 liposomally gene-modified cell preparation alone had a median survival of 46 days. Seventy-five percent of animals receiving IL-2 followed by B7.1 gene-modified tumor vaccines were the only group to show complete tumor-free survival at day 60. All of these surviving animals rejected the parental MBT-2 tumor rechallenge and survived at day 120 with a high CTL response. In conclusion, liposome-mediated transfection demonstrates a clear advantage as compared with the retroviral system in the MBT-2 model. Multi-agent as opposed to single-agent cytokine gene-modified tumor vaccines were beneficial. These "targeted" sequential vaccinations using IL-2 followed by B7.1 gene-modified tumor cells significantly increased a systemic immune response that translated into increased survival.