Increased incidence of Lyme borreliosis in southern Sweden following mild winters and during warm, humid summers

The aim of the present study was to investigate the long-term incidence rate of Lyme borreliosis and, additionally, to determine whether a correlation exists between climatic factors and summer-season variations in the incidence of Lyme borreliosis. Climatic variability acts directly on tick population dynamics and indirectly on human exposure to Lyme borreliosis spirochetes. In this study, conducted in primary healthcare clinics in southeastern Sweden, electronic patient records from 1997–2003 were searched for those that fulfilled the criteria for erythema migrans. Using a multilevel Poisson regression model, the influence of various climatic factors on the summer-season variations in the incidence of erythema migrans were studied. The mean annual incidence rate was 464 cases of erythema migrans per 100,000 inhabitants. The incidence was significantly higher in women than in men, 505 and 423 cases per 100,000 inhabitants, respectively (p<0.001). The summer-season variations in the erythema migrans incidence rate correlated with the monthly mean summer temperatures (incidence rate ratio 1.12; p<0.001), the number of winter days with temperatures below 0°C (incidence rate ratio 0.97; p<0.001), the monthly mean summer precipitation (incidence rate ratio 0.92; p<0.05), and the number of summer days with relative humidity above 86% (incidence rate ratio 1.04; p<0.05). In conclusion, Lyme borreliosis is highly endemic in southeastern Sweden. The climate in this area, which is favourable not only for human tick exposure but also for the abundance of host-seeking ticks, influences the summer-season variations in the incidence of Lyme borreliosis.     

Effect of ethanol on sustained attention in rats

 Acute exposure to ethanol produces deficits in sustained attention in humans, but these attentional deficits have not been modeled in animals. In this study, an operant task was used to investigate the effects of low and moderate doses of ethanol on sustained attention in rats. Performance on a two-choice reaction time task over a 1-h session was assessed immediately following administration of ethanol (0.0, 0.5, 0.75, 1.0 and 1.5 g/kg IP). Each rat was required to respond to a light stimulus of variable duration (20, 100, and 500 ms) occurring at one of two locations. Under control and saline conditions, increases in stimulus length systematically increased choice accuracy and decreased reaction time. Ethanol produced a dose-dependent decrease in choice accuracy that interacted with time, with an initial impairment that was stimulus length-dependent followed by a general vigilance decrement. The data demonstrate that ethanol impaired the ability of rats to direct and sustain attention to brief, infrequent stimuli, and provide a model for further investigations into the underlying neurobiological mechanisms for ethanol-induced attentional deficits. Received: 19 March 1996 / Final version: 30 August 1996     

A randomized comparison of umbilical vein and intravenous oxytocin during the puerperium

Oxytocin was administered in a randomized fashion via either the umbilical or maternal intravenous route. Women who received intraumbilical oxytocin had significantly greater calculated blood loss compared with those who received peripheral administration (P = .01). This greater blood loss was confirmed by a decrease in hematocrit and hemoglobin concentrations after delivery. There was no difference between the groups in the length of the third stage of labor. The incidence of fetomaternal transfusion was higher in the intraumbilical group (P = .07). We conclude that intraumbilical oxytocin is no more beneficial than peripheral administration.     

Susan Britton Wills Unit,Bristol General Hospital,Multidisciplinary, General Hospital and Community Psychiatry

The Susan Britton Wills Unit at the Bristol General Hospital is a small and busy multidisciplinary psychiatric unit, providing a wide range of in-patient, out-patient and day-patient services for the residents of Bristol Health District.

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Effects of estrogen replacement on the progression of coronary-artery atherosclerosis

BACKGROUND: Heart disease is a major cause of illness and death in women. To understand better the role of estrogen in the treatment and prevention of heart disease, more information is needed about its effects on coronary atherosclerosis and the extent to which concomitant progestin therapy may modify these effects. METHODS: We randomly assigned a total of 309 women with angiographically verified coronary disease to receive 0.625 mg of conjugated estrogen per day, 0.625 mg of conjugated estrogen plus 2.5 mg of medroxyprogesterone acetate per day, or placebo. The women were followed for a mean (+/-SD) of 3.2+/-0.6 years. Base-line and follow-up coronary angiograms were analyzed by quantitative coronary angiography. RESULTS: Estrogen and estrogen plus medroxyprogesterone acetate produced significant reductions in low-density lipoprotein cholesterol levels (9.4 percent and 16.5 percent, respectively) and significant increases in high-density lipoprotein cholesterol levels (18.8 percent and 14.2 percent, respectively); however, neither treatment altered the progression of coronary atherosclerosis. After adjustment for measurements at base line, the mean (+/-SE) minimal coronary-artery diameters at follow-up were 1.87+/-0.02 mm, 1.84+/-0.02 mm, and 1.87+/-0.02 mm in women assigned to estrogen, estrogen plus medroxyprogesterone acetate, and placebo, respectively. The differences between the values for the two active-treatment groups and the value for the placebo group were not significant. Analyses of several secondary angiographic outcomes and subgroups of women produced similar results. The rates of clinical cardiovascular events were also similar among the treatment groups. CONCLUSIONS: Neither estrogen alone nor estrogen plus medroxyprogesterone acetate affected the progression of coronary atherosclerosis in women with established disease. These results suggest that such women should not use estrogen replacement with an expectation of cardiovascular benefit.     

February 2003: a 53-year-old male with new onset seizures

The February COM. A 53-year-old obese man presented with new onset seizures and an MRI scan revealed a large cystic and necrotic heterogeneously enhancing left frontal mass. Craniotomy revealed a firm subdural tumor on the cortical surface that was delivered en-bloc preserving the pial planes and stripping it from the falx cerebri. The tumor consisted of multiple irregular fragments of white-tan rubbery tissue admixed with globules of bosselated, white-tan rubbery tissue and a fragment of bone. Sections of the tumor revealed mature hyaline cartilage with no atypia of the chondrocytes. There was focal mineralization and endochondral ossification. A diagnosis of intracranial mesenchymal osteochondroma was made. Osteochondroma, a benign cartilaginous neoplasm comprised of mature hyaline cartilage with focal ossification, is the most common benign bone tumor. Extraskeletal (mesenchymal) osteochondromas are known to originate from non-skeletal or non-cartilaginous tissue. Intracranial osteochondromas are uncommon, typically arising from the base of the skull. Only about 15% of intracranial osteochondromas arise supratentorially, from the dura, usually in a parafalcine frontoparietal location and some have been a component of Maffucci's syndrome and Ollier disease. Intracranial osteochondromas can occur at any age with a predilection for younger individuals. Intracranial mesenchymal osteochondromas exhibit a benign clinical course. Typically, the histomorphology resembles mature hyaline cartilage without anaplastic proliferation of chondrocytes or nuclear atypia, with a lobular arrangement of clusters of lacunae containing single chondrocytes. Transition to osteochondrosarcoma has rarely been documented.     

Topography of basal glucose utilization in the hippocampus determined with [1-14C]glucose and [6-14C]glucose

The activity of the pentose phosphate shunt was assessed under basal conditions in subregions of the hippocampus by measuring the uptake and retention of [1-14C]glucose and [6-14C]glucose and their 14C-labelled metabolites. The relative and absolute retention of carbon-14 from each of the two compounds was nearly identical in all regions examined. For each compound, the highest accumulation of 14C occurred in the granule cell layer of the dentate gyrus and in the pyramidal cell layer. Relatively high retention of radioactivity was also found in the molecular layer of dentate gyrus and in the stratum lacunosum-molecular. The stratum radiatum and stratum oriens contained the lowest levels of radioactivity among hippocampal regions. The equal retention of radioactivity from [1-14C]glucose and [6-14C]glucose implies that pentose phosphate shunt activity is very low throughout the hippocampus under the conditions of this study. The uptake and retention of radioactivity was evaluated in different hippocampal regions 10 or 30 min following intravenous injection of [1-14C]glucose. Although there was significantly more radioactivity at 30 min than at 10 min, the same topographic pattern of radioactivity within the hippocampus was observed in rats after both survival periods, indicating that an equal fraction of the [1-14C]glucose utilized in different hippocampal regions is oxidized to 14CO2 under these conditions. Most regions of high glucose utilization in the hippocampus determined with [1-14C]glucose and [6-14C]glucose correspond to regions of intense histochemical staining for cytochrome oxidase reported in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)