THE INCIDENCE OF BIRTHMARKS IN ISRAELI NEONATES

Background. Several studies have documented cutaneous findings in neonates of various racial groups. Our purpose was to determine the frequency of birthmarks in Israeli neonates of Jewish and Arabic origin. Methods. A cohort of 1672 newborn infants under 96 hours of age were examined for the presence of birthmarks. Of these 841 (50·3%) were Jewish and 831 (49·7%) were Arab. The Jewish group was further subdivided into various ethnic groups according to parental ancestry. Results. Melanocytic brown lesions (Mongolian spots, congenital nevi, and cafe-au-lait spots), were more common in Arab infants. The vast majority of Jewish infants with Mongolian spots were of Asian or African ancestry. On the other hand, congenital melanocytic nevi were found only in Jewish infants of European ancestry. Vascular lesions (salmon patch and port-wine stain) in Arab neonates exhibited a female preponderance. Conclusions. Our data suggest that the prevalence of birthmarks in Israeli neonates is similar to the prevalence reported by others in white neonates.     

A convenient general method for synthesis of Nα- or Nω-dithiasuccinoyl (Dts) amino acids and dipeptides: application of polyethylene glycol as a carrier for functional purification*

N ^α-Dithiasuccinoyl (Dts) amino acids ( 1 ) needed for solid-phase peptide synthesis have been prepared in good yields and excellent purities by a new method that exploits the solubility properties of polyethylene glycol (PEG; bifunctional with average molecular weight 2000 was found to be optimal). Suitably side-chain protected amino acid derivatives are first reacted with a polymeric xanthate ( 11 ), following which the free α-carboxyl is blocked by silylation and the Dts heterocycle is elaborated in the same pot by reaction with chlorocarbonylsulfenyl chloride ( 4 ). Upon aqueous workup, the polymeric carrier removes any urethane blocked amino acids which arise during the process. Exaggerated conditions were explored to prove the power of this functional purification approach, and mechanisms of formation of polymer-bound urethanes are proposed and supported by solution model studies. The preparation and characterization of the companion N-(iso-propyldithio)carbonyl derivative of proline is also presented.     

Regression Equation Predicts Dietary Phosphorus Intake from Estimate of Dietary Protein Intake

Objective To develop a predictive equation for dietary phosphorus intake.

Design In this clinic-based, cross-sectional study, a dietitian-administered food frequency questionnaire provided dietary intake estimates for a population of patients with chronic renal failure. A prediction equation for dietary phosphorus intake was developed and was validated on another sample of patients with CRF from the same clinic.

Subjects Outpatients treated for chronic renal failure at the E. Wolfson Medical Center Institute of Nephrology in Holon, Israel, participated in the study (N=104, 73 men and 31 women, mean AGE=65.6 years). The validation sample consisted of 53 outpatients with chronic renal failure (38 men and 15 women, mean AGE=64.2 years) from the same clinic.

Main outcome measures Dietary variables (ie, energy, protein, carbohydrate, fat, phosphorus) were examined in terms of crude intake, as percentage of total energy intake, and per kilogram of body weight.

Statistical analyses performed Stepwise linear regression analysis and Student's t tests were used to examine relationships between dietary phosphorus and other variables. Results Dietary phosphorus (milligrams)=128+14 (protein intake [grams]) was the best-fitting equation and explained 84% of the variance in dietary phosphorus intake.

Applications The prediction equation for dietary phosphorus intake is especially useful for renal dietitians who calculate patient diets by hand. J Am Diet Assoc. 1996; 96:1268-1270.     

Suppressive Effect of Pregnancy on the Development of Experimental Allergic Encephalomyelitis in Rabbits

ABSTRACT: In the present study we have investigated the influence of pregnancy on the induction and development of experimental autoimmune encephalomyelitis (EAE) in rabbits in relation to the time of gestation. Randomly bred rabbits were immunized with encephalitogenic bovine brain homogenate in complete Freund's adjuvant before or during pregnancy. The appearance of EAE was delayed and occurred only after delivery, abortion, or fetal resorption. The incidence of the disease was lower and the duration longer. The levels of antibodies to myelin basic protein, an autoantigen of EAE, as measured by solid phase radioimmunoassay, were lower in the pregnant rabbits as compared to the nonpregnant animals. The suppressive influence of pregnancy on the induction and the development of EAE confirms previous reports demonstrating amelioration of autoimmune diseases and other immunological reactions during the second half of human pregnancy. This effect might be partially attributed to the increased level of alpha-fetoprotein (AFP) and/or other pregnancy-associated factors in maternal serum.     

Local Electrogram Changes in Response to a High-Voltage Intracardiac Shock in Humans

Electrogram Changes Following ICD Shocks. Introduction: Transvenous defibrillators may have difficulty sensing ventricular fibrillation following an unsuccessful shock. This study was undertaken to characterize the changes that occur in intracardiac electrograms following a defibrillator shock that may contribute to the failure to redetect arrhythmias.
Methods and Results: Unipolar and bipolar electrogram recordings were made during sinus rhythm before and following monophasic and biphasic test shocks delivered in random order through a single lead defibrillator system in 15 patients. An additional 14 patients received only a biphasic shock. Electrogram amplitude, dV/dt, and activation recovery time were determined. Following biphasic shocks, unipolar electrogram amplitude decreased by a mean of 19.6% and the bipolar amplitude by a mean of 20.8% (P = NS). The mean dV/dt in the unipolar recordings decreased by 30.7% and in the bipolar recordings decreased by 33.0% (P = NS). Time constants for recovery were approximately 60 seconds. Reduction in dV/dt was greater when the shocking coil was closer to the distal sensing electrode. There was no significant influence of shock waveform (monophasic vs biphasic), recording type (unipolar vs bipolar), or clinical variables on the change in electrogram characteristics.
Conclusion : Changes in intracardiac electrograms following defibrillator shocks through transvenous leads are seen with shocks delivered in sinus rhythm and may be related to the proximity of the shocking coil to the distal sensing electrode.     

Calcium Carbimide in Alcoholism Treatment. Part 1: a placebo-controlled,double-blind clinical trial of short-term efficacy⋆

A randomized, double-blind, placebo-controlled single cross-over study of the alcohol sensitizing drug, calcium carbimide (CC), was conducted in 128 patients with alcohol dependence. Seventy-one (55%) completed the 4-month study. Patients reported drinking and pill-taking behaviour, and submitted urines (for analysis of alcohol and the tablet marker riboflavin) on 97%, and 91% of treatment days, respectively. All of the 69 analyzable computers were abstinent on at least 85% of days, and 58% (40) were alcohol-free during the study. Medications were taken on at least 85% of days. Symptoms and adverse clinical findings were not increased in frequency during CC, compared to placebo. Seventy-eight per cent of the patients believed they had received CC throughout the study, suggesting that CC exerts a strong psychological deterrent effect. Alcohol consumption was significantly reduced to the same extent with CC and placebo, compared to pre-treatment levels.     

Late Recurrence of Atrial Flutter Following Radiofrequency Catheter Ablation

The success rate for catheter ablation of atrial flutter has been reported to be approximately 90%, but recurrences are common and can be seen in up to 20% of cases. Most of these recurrences are seen within a few weeks following ablation. We report on a patient who developed a recurrence of type I atrial flutter 2 years after an initially successful radiofrequency catheter ablation procedure. Whether the recurrent atriai flutter is due to a new reentrant circuit resulting from slow progression of atrial disease or due to the changes produced by radiofrequency energy in the nearby myocardium is not clear. Further work to define the electrophvsiological changes in the atrial myocardium produced by radiofrequency energy, as well as long-term follow-up of patients undergoing radiofrequency catheter ablation for atrial flutter may help in answering these questions.     

Safety of Long-Term Propafenone Therapy for Cardiac Arrhythmia - Experience with 774 Patients

Long term propafenone therapy was initiated in 774 patients who were evaluated at 27 centers in the United States. The average duration of therapy was 183 days. During the treatment period, at least one toxic side effect occurred in 448 patients (58%). The most common reported adverse reactions were cardiovascular in 209 patients (27%), central nervous system in 160 patients (21%), and gastrointestinal in 159 patients (21%). Of those with cardiovascular side effects, 41 (5.3%) had aggravation of arrhythmia, 26 (3.4%) had the induction or worsening of congestive heart failure, and 65 (8.4%) had new conduction abnormalities. Although side effects were frequent, drug discontinuation due to the adverse reaction was necessary in only 114 patients (14.7%). The majority of side effects were dose related especially when 900 mg/day was administered. Additionally, the incidence of toxicity was directly related to age.
We conclude that side effects are frequent during long-term propafenone therapy, but most are mild, dose related, and do not limit the use of the drug. Drug discontinuation because of an adverse reaction is only infrequently required. It is recommended that drug therapy begin with low doses (150 mg t.i.d) with careful and slow titration up to a maximum of 900 mg/day.     

Simultaneous Assessment of Coronary Flow Reserve and Fractional Flow Reserve with a Novel Pressure-Based Method

Coronary flow reserve (CFR) and fractional flow reserve (FFR_myo) are two guidewire‐based methods currently used to assess the functional severity of coronary artery lesions. Acquiring both measurements simultaneously may provide complementary information, but would require the passage of two different guidewires and complex instrumentation for their calculation. This study assessed the procedural safety and performance of a novel personal computer‐based algorithm, the SmartFlow Intravascular Processor (SFIP), which utilizes a single conventional pressure wire for obtaining simultaneous CFR and FFR_myo measurements for the assessment of coronary artery lesion severity. In 20 consecutive patients with 21 lesions, pressure‐derived CFR, FFR_myo and SFIP‐FFR_myo measurements were obtained during adenosine‐induced hyperemia. Intravascular ultrasound and quantitative coronary angiography lesion analysis was done off‐line at the Washington Core Laboratory. Mean FFR_myo was 0.83 ± 0.11, SFIP‐FFR_myo was 0.86 ± 0.06, and CFR was 1.74 ± 0.46. Pairwise correlation analysis showed excellent correlation between the FFR_myo and the FFR_myo‐SFIP (r²= 0.83, P < 0.0001) and a fair degree of relationship between the CFR and minimal lumen diameter (r²= 0.43, P = 0.07). We could not find a correlation between CFR and FFR_myo (r²= 0.22, P = 0.37), between CFR and FFR‐SFIP (r²= 0.05, P = 0.86), or between the hemodynamic measurements and any of the IVUS‐derived measurements. In conclusion, the SFIP is u novel algorithm for obtaining simultaneous CFR and FFR_myo that may provide valuable information for the assessment of lesion severity and clinical decision making.     

Physicochemical Characterization and Acute Toxicity Evaluation of a Positively-charged Submicron Emulsion Vehicle

Abstract— Fine, homogeneous, positively-charged emulsions with a mean droplet size of 138 ± 71 nm and a zeta potential value of 41.06 mV were prepared using a combination of emulsifiers comprising phospholipids, poloxamer 188, and stearylamine. The pH of these emulsions decreased with time. However, the extent of decrease was dependent on the storage temperature. The mean droplet size of the emulsions that had been prepared with 1% poloxamer began to increase slightly after six months' storage, particularly when stored at 23 and 37°C. However, emulsions prepared with 2% poloxamer remained stable for at least 10 months at 4°C, suggesting that the poloxamer 188 concentration is critical for prolonged emulsion stability. The results of the ocular tolerance study in rabbit eye indicate that hourly administration of a positively-charged emulsion vehicle was well tolerated without any toxic or inflammatory response to the ocular surface during the five days of the study. Scanning electron microscopy revealed a normal corneal surface, which was not different from that of the animals treated with physiological saline. No marked acute toxicity was observed when 0.6 mL of positively-charged emulsion was injected intravenously to BALB/c mice. Furthermore, no difference was noted between this group of animals and the group injected with the marketed Intralipid emulsion. These results were further confirmed in a rat study where there were no deaths following intravenous injection of 3.3 mL per rat of the positively-charged emulsion or Intralipid. Neither emulsion elicited any hepatotoxic or nephrotoxic effects. The overall results suggest that the novel positively-charged emulsion is suitable for parenteral use, and for ocular application.