Presenile dementia in Israel

A nationwide epidemiologic study of presenile dementia of the Alzheimer type (PDAT) with onset through age 60 years was carried out in Israel. The Israeli National Neurologic Disease Register and clinical records of all patients discharged from hospitals between 1974 and 1983 with a neurologic or psychiatric diagnosis suggestive of dementia were reviewed. A total of 71 Jewish patients with onset of PDAT between 1974 and 1978 was ascertained. The age at onset in these patients ranged from 43 to 60 years. The median survival was 8.1 years, with slightly longer survival if onset occurred before age 55 years, even after correction for expected mortality according to age and sex. The average annual incidence rate per 100,000 population at risk was 2.4 in the population aged 40 through 60 years. Although the incidence rates were slightly greater for women, the difference between the rates by sex was not statistically significant. The age- and sex-adjusted incidence of PDAT per 100,000 population was significantly higher in those born in Europe or America (2.9) than in those born in Africa or Asia (1.4). No significant difference in survival was found between these two groups. The curve of the incidence rates by age for PDAT in Israel is continuous with that for senile dementia of the Alzheimer type collected by similar methods elsewhere, which suggests that one disease process may account for both conditions.     

Antibody-dependent enhancement of human immunodeficiency virus type 1 (HIV-1) infection in vitro by serum from HIV-1-infected and passively immunized chimpanzees.

Based on recent reports of antibody-dependent enhancement of human immunodeficiency virus type 1 (HIV-1) infection in vitro by serum from HIV-1-infected humans, sera from HIV-1 antibody-positive chimpanzees (Pan troglodytes) was evaluated for enhancing activity in an in vitro infection assay that uses MT-2 cells (a human lymphoblastoid cell line). Although fresh chimpanzee serum was found to have pronounced infection-enhancing properties in the absence of antibody to HIV-1, this effect was abolished by heat inactivation (57 degrees C, 1 hr) or treatment with cobra venom anticomplementary protein. Heat-inactivated, HIV-1 antibody-positive chimpanzee serum could enhance HIV-1 infection of MT-2 cells in vitro when combined with fresh, normal human serum. By serial serum samples from three HIV-1-infected chimpanzees, HIV-1 antibody-positive chimpanzees are shown to develop enhancing antibodies early in infection (2 mo postchallenge), whereas neutralizing antibodies develop later. Over the course of HIV-1 infection, this enhancing activity decreases while neutralizing activity increases, suggesting a possible role for enhancing and neutralizing activities in HIV-1 pathogenesis. The enhancing activity of an IgG fraction used to passively immunize chimpanzees against HIV-1 infection is shown to be present at dilutions as high as 1:65,000, offering an interesting possible reason for the failure of passive immunization to protect chimpanzees from HIV infection. These results suggest that serum from HIV-1-immunized chimpanzees might be tested to determine whether current HIV-1 candidate vaccines induce production of antibodies that mediate antibody-dependent enhancement of HIV-1 infection in this in vitro assay.     

M?glichkeiten und Grenzen einer ambulanten Antibiotikatherapie der infekti?sen Endokarditis

Hintergrund: Die infektiöse Endokarditis hat eine hohe Morbidität und Letalität. Daher erfolgt die Antibiotikatherapie stets intravenös und über mehrere Wochen. Patientenauswahl für ambulante Behandlung: Für eine ambulante antibiotische Therapie sind nur ausgewählte Patienten geeignet, bei denen eine kontinuierliche intravenöse Gabe auch an den Wochenenden gewährleistet ist. Generell sollten außerdem nur hämodynamisch stabile und ansonsten komplikationsfreie Patienten, bei denen der auslösende Erreger nachgewiesen wurde, ambulant behandelt werden. Durchführung: Unter pharmakologischen Gesichtspunkten sollte über die gesamte Therapiedauer eine intravenöse oder intramuskuläre Gabe der Antibiotika erfolgen. So kann eine Endokarditis, verursacht durch penicillinsensible Streptokokken, der größten Gruppe unter den Endokarditiserregern, mit einer einmal täglichen Gabe von Ceftriaxon parenteral über 4 Wochen auch ambulant suffizient behandelt werden. Für alle anderen Erreger liegen noch keine ausreichenden Daten bezüglich einer ambulanten Therapie vor. Die meist komplexeren Antibiotikaregime für diese Erreger sind für den ambulanten Gebrauch wenig praktikabel. Computergesteuerte Pumpen können diese Nachteile in Zukunft möglicherweise überwinden. Grenzen: Jede geplante ambulante Therapie sollte in den ersten Tagen unter stationären Bedingungen eingeleitet und erst nach Ansprechen der Therapie ambulant fortgesetzt werden. Zur Zeit lässt die ambulante Infrastruktur eine verlässliche, ambulante Therapie und Verlaufskontrolle an 7 Tagen in der Woche problematisch erscheinen. Dennoch bietet die ambulante Antibiotikatherapie gegenüber der stationären bezüglich des Kosten-Nutzen-Effekts zukünftig eine interessante Alternative. Background: Infective endocarditis has a high morbidity and letality. Therefore antibiotic treatment has to be intravenous to achieve high blood levels and has to last several weeks without an interruption of treatment at the weekends. Patient Selection for Outpatient Therapy: It is therefore crucial to select the patient group that is suited for an outpatient, antibiotic therapy very carefully. In general only hemodynamically stable patients without complications in whom the responsible organism has been identified should be considered. Treatment: From a pharmacological point of view intravenous or intramuscular application for the complete duration of therapy is obligatory. Endocarditis caused by penicillin-susceptible streptococci, the biggest group of organisms responsible for endocarditis, can be treated with Ceftriaxon once daily for 4 weeks. For other organisms there are at present no data available which support the feasibility of an outpatient therapy. In particular antibiotic therapy with a complex regimen for those organisms is not practicable for outpatient usage. Possibly, in the near future computer controlled pumps might overcome this disadvantage. Limits: Every outpatient therapy should be initiated under inpatient conditions and only after an initial response to the antibiotic therapy continued in an outpatient setting. Today reliable outpatient therapy and follow-up 7 days a week under the given outpatient infrastructur is problematic and remains an exception. However, considering cost-effectiveness outpatient as compared to inpatient antibiotic therapy could be an interesting economically advantageous alternative.     

Angiography, CT and MR imaging of a high vena cava inferior interruption in a patient with Hirschsprung disease.

We report on a high vena cava inferior interruption immediately at the insertion to the right atrium in a patient with Hirschsprung disease assessed by angiography, CT, and MRI. Hirschsprung disease is frequently associated with Down, Undine, Waardenburg, Bardet-Biedl, Smith-Lemli-Opitz and Goldberg-Sphrintzen syndromes. We suggest that the association of these two malformations are most likely interrelated and should be considered as a new syndrome.     

Transient ischemic attacks: their frequency in the Lehigh Valley

The incidence of transient ischemic attacks (TIAs) in the Lehigh Valley was analyzed using the Lehigh Valley Stroke Register based on data collected between July 1, 1982, and June 30, 1986. The overall average annual incidence rate was 22.9 per 100,000 population, and 23.2 and 22.5 per 100,000 population in men and women, respectively. Men had a statistically significant higher age-specific rate of TIAs than women. Our incidence appears to be lower than that reported in earlier studies but, because of methodologic differences, only continued observations in our population and in similar populations using a standardized methodology will resolve the question of whether TIA frequency is, in fact, declining.     

Systemic recombinant alpha-2 interferon therapy in relapsing multiple sclerosis

This report describes the first use of recombinant-DNA-produced human interferon in patients with multiple sclerosis (MS). Ninety-eight patients who were clinically definite for MS with two or more documented exacerbations during the preceding two years were admitted to this placebo-controlled double-blind randomized trial. Although both groups were similar, placebo patients had later MS onset. Patients injected themselves with 2 X 10(6) IU of alpha-2 interferon or placebo three times each week for up to 52 weeks. This dose of interferon was well tolerated in that side effects were minimal. During the trial, the exacerbation rate was sharply reduced in both groups. In the three-month follow-up period after stopping treatment, more patients who were receiving interferon than placebo became worse neurologically. More patients who were receiving interferon than placebo changed from exacerbating MS to progressive MS during the trial. Thus, no clear therapeutic benefit of alpha-2 interferon for MS was detected.     

Standardized incidence ratios of stroke: a worldwide review

Comparison of stroke incidence in various parts of the world is difficult because differences in diagnostic criteria, medical facilities and age-sex distributions are often not taken into account. We calculated age-sex standardized incidence ratios (SIR) of stroke in 37 regions based on recent reports. The USA (1976) was taken as the standard population. In western countries SIRs varied from 0.8 to 2.1. In China and Japan, SIRs varied from 0.7 to 3.6. While the lowest and highest SIRs differed by a factor of 5, only 6 of the 37 studies yielded a SIR of more than 2.0 or below 0.75. Of these, 4 were from China and Japan. The highest ratios were based on a very intensive door-to-door survey and probably should not be compared to less intensive studies. We conclude that world-wide variation in age-sex adjusted stroke rates is relatively small.     

Rezidivierende Synkopen bei Linksschenkelblock mit normaler PQ-Zeit

Wir berichten den Fall einer 53-j?hrigen Patientin, die sich wegen rezidivierender Synkopen zur station?ren Aufnahme vorstellte. Im Oberfl?chen-EKG fand sich ein Sinusrhythmus mit normaler PQ-Zeit und komplettem Linksschenkelblock. Echokardiographisch wurde eine auf ca. 45% reduzierte Pumpfunktion ermittelt. Unter dem Verdacht einer entzündlichen Herzmuskelkrankung wurde eine Herzkatheteruntersuchung mit Endomyokardbiopsie durchgeführt, deren histologische und immunhis-tologische Untersuchung keinen Anhalt für eine Myokarditis oder Speichererkrankung ergab. Die elektrophysiologische Untersuchung zeigte ein stark verl?ngertes HV-Intervall von 101 ms (normal 35–55 ms). Daraufhin wurde ein Zweikammerschrittmachersystem (DDD) implantiert. Eine Untersuchung nach 3 Monaten zeigte die bereits eingetretene Schrittmacherabh?ngigkeit der Patientin bei komplettem AV-Block ohne ausreichenden Ersatzrhythmus.