Kleine-Levin syndrome: a systematic review of 186 cases in the literature.

Kleine-Levin syndrome (KLS) is a rare disorder with symptoms that include periodic hypersomnia, cognitive and behavioural disturbances. Large series of patients are lacking. In order to report on various KLS symptoms, identify risk factors and analyse treatment response, we performed a systematic review of 195 articles, written in English and non-English languages, which are available on Medline dating from 1962 to 2004. Doubtful or duplicate cases, case series without individual details and reviews (n = 56 articles) were excluded. In addition, the details of 186 patients from 139 articles were compiled. Primary KLS cases (n = 168) were found mostly in men (68%) and occurred sporadically worldwide. The median age of onset was 15 years (range 4-82 years, 81% during the second decade) and the syndrome lasted 8 years, with seven episodes of 10 days, recurring every 3.5 months (median values) with the disease lasting longer in women and in patients with less frequent episodes during the first year. It was precipitated most frequently by infections (38.2%), head trauma (9%), or alcohol consumption (5.4%). Common symptoms were hypersomnia (100%), cognitive changes (96%, including a specific feeling of derealization), eating disturbances (80%), hypersexuality (43%), compulsions (29%), and depressed mood (48%). In 75 treated patients (213 trials), somnolence decreased using stimulants (mainly amphetamines) in 40% of cases, while neuroleptics and antidepressants were of poor benefit. Only lithium (but not carbamazepine or other antiepileptics) had a higher reported response rate (41%) for stopping relapses when compared to medical abstention (19%). Secondary KLS (n = 18) patients were older and had more frequent and longer episodes, but had clinical symptoms and treatment responses similar to primary cases. In conclusion, KLS is a unique disease which may be more severe in female and secondary cases.

Normal human monocytes inhibit tumor cell growth in vitro.

Normal human monocytes were evaluated in an in vitro assay of growth inhibition of tumor cells. Monocytes were isolated from the blood of 6 normal subjects by Ficoll-Hypaque separation and adherence to plastic microtest wells. Cervical carcinoma cells (HeLa) were added to the microwells to result in a ratio of 50 monocytes to one HeLa cell. Cultures were then incubated for 6 to 46 hr. Growth inhibition was evaluated by measuring the uptake of 3H-thymidine over a 4-hr pulse period after 2, 18, or 42 hr of monocyte-HeLa interaction. Inhibition of HeLa growth by monocytes was 23.8% +/- 8.6% over 6 hr, 22.0% +/- 8.9% over 22 hr. and 68.3% +/- 7.5% over 46 hr. Growth inhibition of HeLa cells was confirmed by direct enumeration of HeLa cells at the end of coincubation. Attachment of monocytes to the HeLa cells was confirmed by light and scanning electron micrographs. Granulocytes, lymphocytes, and other cell lines did not comparably inhibit HeLa growth and media replenishment did not ablate the effect. These data demonstrate that normal human monocytes can inhibit the growth of a malignant cell line in vitro in the absence of overt activation procedures.