Takayasu arteritis. An arteriographic-pathological correlation.

We report an aortographic-pathological correlation in a patient with Takayasu arteritis. The inflammatory activity in Takayasu arteritis gradually subsides and accordingly, the histological appearance goes through a cycle of changes, ranging from acute florid inflammation to an old scarred vessel. At gross pathological inspection, the aortic intima frequently shows longitudinal wrinkling and tree-barking indistinguishable from syphilitic aortitis. In other instances, secondary atherosclerosis totally obscures the underlying changes of aortitis. In such instances, close search at various levels of the aorta is likely to uncover persistent foci of arteritis and thereby permit identification of the pathological changes as secondary to previous aortitis.     

MR evaluation of liver iron overload

Children and young adults with hemolytic anemias requiring frequent transfusions develop increased liver iron content. We evaluated 15 chronically transfused children with sickle cell disease to determine whether spin-echo magnetic resonance (MR) imaging was useful in assessing the degree of iron overload. Quantitative MR parameters were correlated with liver biopsy iron determinations and serum ferritin levels. The best predictor of liver iron was the ratio of the intensities between the liver and paraspinal musculature on somewhat T1 weighted sequence (repetition time 0.5 s, echo time 28 ms), R2 = 0.58. Magnetic resonance was able to separate those patients with liver iron levels greater than 100 micrograms/mg (intensity ratios approximately 0.4), from those with levels less than 100 micrograms/mg (intensity ratios near 1). However, MR was unable to quantitate liver iron in patients with values ranging from 100 to 400 micrograms/mg since similar intensity ratios were present in this range. Thus, MR provides a qualitative rather than quantitative assessment of liver iron overload.     

Prolongation of sickle cell survival by dimethyl adipimidate is compromised by immune sensitization

The effect of dimethyl adipimidate (DMA), an amino-reactive crosslinking reagent with demonstrated antisickling properties in vitro, on the survival of 51Cr-labeled autologous sickle cells was evaluated in five adult males with sickle cell anemia. The survival of cells pretreated with 5 mmol/L DMA (pH 7.4), normal (t1/2 28-33 days) in four subjects and near-normal (t1/2 20 days) in the fifth, was considerably longer than that usually observed in sickle cell disease. In fact, the effect of DMA on the survival of sickle cells in vivo equals or exceeds that of any other agent tested to date. In three subjects, the survival of a second infusion of DMA-treated red cells was much shorter (t1/2 1.8, 3, 4.5 days) than in the initial study. An antibody was detected in the serum of these subjects that was directed to DMA-treated red cells. Modification of the immunogenicity of treated cells will be required before further consideration of DMA for use in the therapy of sickle cell anemia.     

Survey of Alcohol Use in the U.S. Army

ABSTRACT

The objective of this study was to collect data that would provide information about the frequency, attitudes, and consequences of alcohol use in the U.S. Army. A questionnaire was used to assess the frequency of alcohol consumption, attitudes related to the use of alcohol, and adverse consequences experienced with alcohol use. The survey was conducted at Walter Reed Army Medical Center in Washington, D.C. Survey participants included both military employees working at Walter Reed Army Medical Center and military patients. No attempt was made to identify the medical status of the participants. The investigators distributed 1,200 questionnaires. Following distribution, the investigators received 1,010 completed questionnaires, resulting in an 84% return rate. Thirty-four percent of the survey participants (n = 335) were deployed to an area of combat operations. There was a significant difference in binge drinking between military personnel assigned to an area of combat operations and those not assigned to an area of combat operations (p = 0.023). Multiple regression results showed that age, marital status, and deployment status were correlated with four or more drinks at one time (p < 0.001). In other words, binge drinking is more likely to occur among military personnel who are younger, experiencing marital problems, and recently returned from an area of combat operations. Significant differences between the two groups also emerged in terms of other specific consequences associated with consumption. Deployment to an area of combat operations seems to influence consumption patterns, alcohol related attitudes, and behaviors. This could be a consequence of wartime experiences. This study should help guide the clinical screening of alcohol use disorders, which may complicate emotional recovery from traumatic experiences if undetected.     

High prevalence of the hemochromatosis-associated Cys282Tyr HFE gene mutation in a healthy Norwegian population in the city of Oslo, and its phenotypic expression.

BACKGROUND: Previous studies have shown that 5%-10% of white subjects are heterozygous for the HFE gene C282Y mutation, which is associated with hemochromatosis. The aim of our study was to determine the prevalence of heterozygosity and homozygosity for the C282Y HFE gene mutation and its phenotypic expression in a group of healthy Norwegians. METHODS: Fasting blood samples were obtained from 505 unrelated hospital employees. Serum iron, transferrin, and serum ferritin were measured. Transferrin saturation was calculated. The presence of HFE gene mutation was determined with a polymerase chain reaction-based analysis. RESULTS: Two of the 505 subjects (0.4%) were homozygous and 75 (14.9%) were heterozygous for the C282Y mutation. Median serum ferritin among the heterozygotes was 59 microg/l, compared with 47 microg/l among individuals without the C282Y mutation (P = 0.12). Median transferrin saturation among the heterozygotes was 31%, compared with 24% among individuals without C282Y mutation (P < 0.001). Twenty-three individuals (4.6%) had a serum ferritin level > 200 microg/l. Eight of these (35%) had the C282Y mutation: two homozygotes and six heterozygotes. Transferrin saturation > 50% was observed in 25 individuals (5.0%). Twelve of these (48%) had the C282Y mutation; two were homozygotes and 10 heterozygotes. Only eight individuals (1.6%) had a transferrin saturation > 60%: one homozygote, five heterozygotes, and two individuals without mutation. CONCLUSIONS: Fifteen per cent of a healthy Norwegian population is heterozygous for the HFE gene mutation C282Y. This is among the highest reported prevalence values among healthy individuals. Half of the subjects with transferrin saturation greater than 50% were carriers of the C282Y mutation.