Periodicity and prediction of mania onsets in biopolar I affective disorders

Abstract In studying the periodicity of mania onsets, cycle-oriented diagrams were made of the clinical course from 257 manic episodes analyzed retrospectively in 34 bipolar I manic-depressive patients for a period of about 5 years. Using these diagrams, the frequent period of mania onsets located in one-quarter of the follow-up period was pre-estimated, and the accordance ratio during a 25 month follow-up period was analyzed. The accordance ratio in all subjects was 39% (11/28) for the first episode and 35% (7/20) for the second episode. These ratios were not significantly different from the expected level (25%). The number of subjects was limited to 11 patients (10 rapid and 1 non-rapid cyclers) whose number of episodes used for the determination of the index cycle was eight or more. The accordance ratio was 64% (7/11) and 60% (6/10) for the first and second episodes, respectively. Their levels were significantly higher than those expected. Periodicity of mania onsets existed at least in rapid cyclers with abundant past data.     

SPINAL CORD VASCULARITY. A HISTOPATHOLOGICAL AND ANGIOGRAPHIC STUDY OF THE EFFECTS OF THORACIC-LUMBAR AORTIC MOBILIZATION IN THE RAT

A clinical, histopathological and microangiographical study has been performed in eighty-three rats subjected to regional mobilization of the thoracic-lumbar aorta. Paralysis or paresis of the hindlimbs was observed in about one-fourth of the animals, predominantly in those subjected to an extensive mobilization of the aorta. A staged mobilization of the thoracic-lumbar aorta separated by an interval of 1 week not only minimized the incidence of neurological complications but the severity as well. The topographical distribution of the histopathological changes varied considerably both in the longitudinal and the transverse plane of the spinal cord in different experimental groups as well as individually in the same group of animals. Typical lesions were dorsal spinal cord infarction and arterial watershed lesions at the base of the dorsal horn, in addition to circumscribed necroses of the white matter corresponding fairly well to venous watershed zones. Microangiographically, the preservation of the caudal cord in cases with massive infarction of the thoracic cord, is believed to be due to a number of intramedullary arterial anastomoses. Usually a sufficient collateral blood supply to the spinal cord is readily available even in the case of comparatively extensive aortic mobilization. Enlargement and tortuosity of the spinal cord arteries and the intersegmental anastomoses immediately outside the spinal canal suggest that these vessels are the most important sources in the re-establishment of the collateral circulation.     

SMOKING IN PREGNANCY AND SUBSEQUENT DEVELOPMENT OF THE CHILD

Summary Data from the National Child Development Study have been used to examine the relationship between mother's smoking during pregnancy and neonatal mortality, birthweight and the subsequent development of the child to the age of 11. In this paper analyses are reported which extend this work to examine development by the age of 16. After allowing for a wide range of related background factors, it is found that mothers smoking during pregnancy continues to be related to the child's reading and mathematics attainment. For boys, but not girls, there is an association with height. An inconsistent relationship is found with the child's history of asthma and wheezy bronchitis. Some doubts about the direct causality of such relationships are discussed.     

Endoscopic Reduction of Acute Gastric Volvulus in a Child

Abstract: An 11-year-old girl with cerebral palsy was admitted with complaints of frequent vomiting and upper abdominal distension. After plain X-ray examination and upper gastrointestinal contrast study, she was diagnosed as having acute mesenterioaxial volvulus of the stomach. Endoscopic reduction was successfully performed. We describe herein the technical details of the endoscopic reduction in this rare case. In non-infant pediatric patients with primary gastric volvulus, we recommend that endoscopic reduction be considered prior to surgical intervention.     

Differences in immune recognition of cytochrome P4502D6 by liver kidney microsomal (LKM) antibody in autoimmune hepatitis and chronic hepatitis C virus infection

LKM-1 antibody, which characterizes a subtype of autoimmune hepatitis (AIH), is also found in some patients with chronic hepatitis C virus (HCV) infection. It has been suggested that HCV initiates autoimmunity through molecular mimicry, because there is partial identity between HCV and cytochrome P4502D6 (CYP2D6), the putative target of LKM-1. Whether CYP2D6 is the target of LKM-1 in HCV-related liver disease, however, is controversial. To clarify this issue, we have studied by phage plaque assay and Western blot the reactivity to recombinant CYP2D6, isolated from a human liver cDNA library, in 55 patients with LKM-1, 18 (14 females, median age 12 years) anti-HCV-negative, with classical AIH, and 37 (27 females, median age 52 years) anti-HCV-positive. Reactivity to CYP2D6 was found in 72% of the anti-HCV-negative, but only in 27% of the anti-HCV-positive patients (P < 0.001), although immunofluorescence LKM-1 titres were similar in the two groups. In addition, to investigate whether the antibody responsible for the LKM-1 fluorescent pattern also reacts with CYP2D6, we have determined the specificity of LKM-1 antibodies present in the supernatant of lymphoblastoid B cell lines obtained from two patients with LKM-1-positive AIH. An oligo/monoclonal antibody thus generated gave both the typical fluorescent pattern and reacted with CYP2D6. Our results show that whilst antibodies producing the characteristic LKM-1 fluorescent pattern can react with CYP2D6, not all LKM-1-positive sera do so, particularly if obtained from patients with chronic HCV infection. This suggests that LKM-1 in HCV infection recognizes epitopes or antigens different from those targeted in AIH.     

PROGNOSTIC VALUE OF ANGIOGENESIS IN OPERABLE NON-SMALL CELL LUNG CANCER

Tumour angiogenesis is an important factor for tumour growth and metastasis. Although some recent reports suggest that microvessel counts in non-small cell lung cancer are related to a poor disease outcome, the results were not conclusive and were not compared with other molecular prognostic markers. In the present study, the vascular grade was assessed in 107 (T1,2–N0,1) operable non-small cell lung carcinomas, using the JC70 monoclonal antibody to CD31. Three vascular grades were defined with appraisal by eye and by Chalkley counting: high (Chalkley score 7–12), medium (5–6), and low (2–4). There was a significant correlation between eye appraisal and Chalkley counting ( P <0·0001). Vascular grade was not related to histology, grade, proliferation index (Ki67), or EGFR or p53 expression. Tumours from younger patients had a higher grade of angiogenesis ( P =0·05). Apart from the vascular grade, none of the other factors examined was statistically related to lymph node metastasis ( P <0·0001). A univariate analysis of survival showed that vascular grade was the most significant prognostic factor ( P =0·0004), followed by N-stage ( P =0·001). In a multivariate analysis, N-stage and vascular grade were not found to be independent prognostic factors, since they were strongly related to each other. Excluding N-stage, vascular grade was the only independent prognostic factor ( P =0·007). Kaplan–Meier survival curves showed a statistically significant worse prognosis for patients with high vascular grade, but no difference was observed between low and medium vascular grade. These data suggest that angiogenesis in operable non-small cell lung cancer is a major prognostic factor for survival and, among the parameters tested, is the only factor related to cancer cell migration to lymph nodes. The integration of vascular grading in clinical trials on adjuvant chemotherapy and/or radiotherapy could substantially contribute in defining groups of operable patients who might benefit from cytotoxic treatment.