Effects of adrenaline infusion on platelet number, volume and release reaction

At the end of a diagnostic right heart catheterization ten patients received an intravenous infusion of l-adrenaline which gradually increased the arterial plasma adrenaline concentration from resting physiological values to high values as seen during myocardial infarction, pheochromocytoma and hypoglycemia. Blood was sampled from the brachial artery, femoral vein and hepatic vein. During the adrenaline infusion venous beta-thromboglobulin concentrations increased 23% from 61 +/- 5 to 80 +/- 7 micrograms/l (mean +/- SE), arterial platelet counts 20% from 212 +/- 17 to 253 +/- 25 X 10(9)/l and arterial platelet volume 4% from 7.25 +/- 0.20 to 7.56 +/- 0.21 femtoliter. All changes were significant at the 5% level. Thus, acute increments of arterial plasma adrenaline significantly stimulated the blood platelet parameters studied.     

Comparison of olanzapine and risperidone in 367 first-episode patients with non-affective or affective psychosis: results of an open retrospective medical record study

INTRODUCTION: Previous studies comparing olanzapine (OLZ) and risperidone (RIS) have tended to focus on multiple-episode patients, with no studies examining their comparative efficacy in a non-selective sample of first-episode psychosis. METHODS: The Early Psychosis Prevention and Intervention Centre in Australia had admitted 786 first-episode psychosis (FEP) patients between 1998-2000. Data were collected from the medical records (MR) of 367 patients, which met inclusion criteria. The primary objective was to evaluate the efficacy of OLZ vs. RIS as measured by CGI-S, CGI-BP (symptomatic level), GAF and SOFAS (functioning level). RESULTS: 367 FEP patients were entered into the study, 278 in the RIS- (2.7 mg/day) and 89 in the OLZ group (10.2 mg/day). No between-group differences were found in non-affective FEP (n = 273). In affective FEP patients (n = 94), mainly treated for acute mania (86.7 %), OLZ treatment was related to better response on the symptomatic (CGI-S; p = .002), but not on the functioning level (GAF and SOFAS; ns). There were trends in the OLZ group towards a higher rate of remission of positive symptoms ( p = .054) and a shorter treatment duration to reach this remission in affective FEP patients ( p = .077). More extrapyramidal side effects ( p <.001) were related to RIS and more weight gain to OLZ-treatment ( p <.001). DISCUSSION: Despite the limitations of a retrospective MR design, study results suggest equal therapeutic efficacy of OLZ and RIS in non-affective FEP and some therapeutic advantages of OLZ compared to RIS in affective FEP patients, especially in those with acute mania. Results may serve as hypotheses for future randomised controlled trials.     

Chronic mucocutaneous candidiasis and primary hypothyroidism in two families

We describe the clinical and immunological features of two families with chronic mucocutaneous candidiasis (CMC) and primary hypothyroidism. Family A includes three siblings with both candidiasis and hypothyroidism and four individuals with hypothyroidism only. Family B includes four members with candidiasis, of whom one (a male child) also had hypothyroidism. All individuals affected with CMC had suffered from oral candidiasis and onychomycosis since infancy. Facial seborrhoic dermatitis, general folliculitis and scaling blepharitis were main manifestations. Hypothyroidism became evident during childhood. No thyroid antibodies were present in the affected siblings in family A, while the male in family B with hypothyroidism had antibodies against thyroid peroxidase at diagnosis. Immunological evaluation revealed intra-individual variations in serum immunoglobulin levels, lymphocyte subsets and proliferative responses, but there were no consistent abnormalities. Vaccine responses were normal. AIRE gene region microsatellite markers did not segregate with disease nor were autoantibodies typical for autoimmune polyendocrine syndrome type 1 detected in the families. Conclusion: the link between hypothyroidism and chronic mucocutaneous candidiasis remains to be identified.Abbreviations AADC aromatic l -amino acid decarboxylase - APS 1 autoimmune polyendocrine syndrome type 1 - CMC chronic mucocutaneous candidiasis - GAD glutamic acid decarboxylase - MBL mannose-binding lectin - 17OH 17-hydroxylase - 21OH 21-hydroxylase - SCC side-chain cleaving enzyme - TG-Ab anti-thyroglobulin antibodies - TPO-Ab anti-thyroperoxidase antibodies     

Children grow and horses race: is the adiposity rebound a critical period for later obesity?

Background  

The adiposity rebound is the second rise in body mass index that occurs between 3 and 7 years. An early age at adiposity rebound is known to be a risk factor for later obesity. The aim here is to clarify the connection between the age at rebound and the corresponding pattern of body mass index change, in centile terms, so as to better understand its ability to predict later fatness.     

High screening blood pressure is related to sympathetic nervous system activity and insulin resistance in healthy young men

The cardiovascular metabolic syndrome is characterized by the presence of several cardiovascular risk factors, including blood pressure (BP) elevation. We aimed to study the relation between mental stress, plasma catecholamines, BP and BP responses to mental stress in healthy young Caucasian men selected from different levels of screening BP. We included 98 men with high and 22 men with normal screening BP. They were examined at baseline in the laboratory, during a hyperinsulinemic, isoglycemic glucose clamp and during mental stress. At baseline in the laboratory, the men with high screening BP were characterized by elevated BP (p < 0.005) and plasma catecholamines (p < 0.05), but unaltered serum lipid levels compared to men with normal screening BP. After 2 h rest the differences almost disappeared, but could be reproduced during a mental arithmetic stress test. The men with elevated screening BP had significantly higher fasting glucose (p = 0.01) and lower insulin sensitivity (p < 0.005). In a multiple regression model, norepinephrine during mental stress (R2 = 0.10, p < 0.05) was the main variable to retrospectively explain allocation to the normal or high screening BP group. In conclusion, young healthy men with elevated screening BP are characterized by increased sympathetic activity and insulin resistance. Norepinephrine during mental stress is the main variable to explain allocation to the normal or elevated screening BP group. We have shown that one single screening BP measurement predicts insulin resistance and elevated fasting glucose in this cohort.     

The relationship between intracranial pressure and size of cerebral ventricles assessed by computed tomography

Summary.  Background: This study explored whether assessment of the cerebral ventricular size (or changes in size) by cranial computed tomography (CT) is a reliable way to predict the intracranial pressure (ICP).  Methods: A total of 224 cranial CT scans and continuous 24 hours ICP recordings in 184 patients were examined and compared. In these cases examinations were undertaken on the basis of suspected craniosynostosis, hydrocephalus or extracranial shunt failure. Simultaneous CT scanning and ICP monitoring was performed twice in 31 cases. Various measures of cerebral ventricular size were computed on the basis of CT, including Evan's index, third ventricular index, cella media index and ventricular score. Various measures of ICP were computed by means of the software Sensometrics^TM Pressure Analyser, including computation of mean ICP, numbers of ICP elevations (20–30 mmHg lasting either 0.5, 1, 5 or 10 minutes), and numbers of ICP depressions (−5 or −10 mmHg lasting either 0.5, 1, 5 or 10 minutes) during a standardized recording time of 10 hours. The relationships between the various measures of ventricular size and the various measures of ICP were explored.  Findings: There was a weak and non-significant relationship between the various measures of ventricular size and the measures of ICP in the 184 cases. There was a weak relationship between changes in size of cerebral ventricles and changes in ICP in the 31 cases examined twice.  Interpretation: The present results suggest that actual size or changes in size of the cerebral ventricles were no reliable predictors of ICP or changes in ICP, suggesting that great caution should be exercised when predicting ICP on the basis of the size of the cerebral ventricles on cranial CT scanning. Published online March 3, 2003 Acknowledgments  The author thanks Professor Thore Egeland, Section of Medical Statistics, University of Oslo for help during the statistical evaluation of the data.  Correspondence: Per Kristian Eide M.D., Ph.D., Department of Neurosurgery, The National Hospital, Sognvannsveien 20, N-0027 Oslo, Norway.     

External beam irradiation therapy for choroidal haemangiomas. Visual and anatomical results after a dose of 20 to 25 Gy

PURPOSE: To evaluate the visual and anatomic results of radiation therapy in ten patients with choroidal haemangiomas. METHODS: Nine patients with circumscribed choroidal haemangiomas and one with diffuse choroidal haemangioma have been reviewed retrospectively. They were treated by lens-sparing external beam radiation therapy (20--24 Gy) (9 eyes) and plaque brachytherapy (25 Gy) (1 eye), respectively. RESULTS: The visual acuity improved by two lines or more in 8 of 10 eyes. No eyes showed deterioration of visual acuity. In all cases the retinal detachment showed complete resolution. A regression in tumour thickness was observed in all cases, and a reduction of anisometropia in cases with submacular infiltration by the tumour. During follow-up (0.4--8.8 years) there were no signs of radiation cataract, retinopathy or optic neuropathy. CONCLUSIONS: External beam radiation (20--25 Gy) is a reasonable alternative for treatment of symptomatic choroidal haemangiomas.     

Acute hepatotoxicity after high-dose methotrexate administration to rats.

Acute hepatotoxicity after administration of 10-1000 mg/kg methotrexate (MTX) to rats was studied by monitoring serum transaminases, liver morphology, and disposition kinetics of MTX and 7-hydroxy-methotrexate (7-OH-MTX). Half the control rats and rats administered 1000 mg/kg MTX, had their bile duct cannulated. One to 2 hr after administration of 1000 mg/kg MTX, 50% of MTX treated bile-drained rats (Ebc) developed cholestasis despite similar or larger initial bile flow rates than those which did not develop cholestasis (Ebn, controls). In Ebc animals, peak serum ASAT and ALAT levels were 6- and 4-fold higher than that of the control rats, and morphologically, prominent hepatocytic changes and grossly dilated bile canaliculi were found. Immediately prior to cholestasis, the Ebc animals reached biliary 7-OH-MTX levels (8.3 +/- 1.3 mM, mean +/- S.E.M.) which were equivalent to the threshold level for precipitation of 7-OH-MTX in rat bile in vitro, and 3-fold higher than the corresponding levels of 7-OH-MTX in the bile of Ebn rats. Ninety-five % of the drug in the precipitated material was 7-OH-MTX. Hence, 7-OH-MTX may play a role in acute MTX hepatotoxicity, a dose-limiting toxicity that may not be counteracted by leukovorin rescue.