The severity of autism is associated with toxic metal body burden and red blood cell glutathione levels.

This study investigated the relationship of children's autism symptoms with their toxic metal body burden and red blood cell (RBC) glutathione levels. In children ages 3-8 years, the severity of autism was assessed using four tools: ADOS, PDD-BI, ATEC, and SAS. Toxic metal body burden was assessed by measuring urinary excretion of toxic metals, both before and after oral dimercaptosuccinic acid (DMSA). Multiple positive correlations were found between the severity of autism and the urinary excretion of toxic metals. Variations in the severity of autism measurements could be explained, in part, by regression analyses of urinary excretion of toxic metals before and after DMSA and the level of RBC glutathione (adjusted R(2) of 0.22-0.45, P < .005 in all cases). This study demonstrates a significant positive association between the severity of autism and the relative body burden of toxic metals.

Thyrotoxicosis-induced congestive heart failure in an urban hospital.

Thyrotoxicosis has been associated with several cardiac complications, including atrial fibrillation (AF), functional cardiomyopathy, and congestive heart failure (CHF). Thyrotoxicosis-induced CHF has been considered an unusual complication of thyrotoxicosis, occurring generally in older patients. To determine the nature and frequency of this complication of thyrotoxicosis in an adult, hospitalized population, the authors consecutively evaluated all admissions to a 535-bed urban hospital during a 14-month period. Admitted during the study period were 177 individuals with a principal diagnosis of AF and 21 individuals with a principal diagnosis of thyrotoxicosis. Eleven of these individuals had concomitant AF and thyrotoxicosis, which was 6% of the AF group. Of these 11 patients, 5 had clinically apparent CHF without evidence of other organic heart disease (Group A) and 6 had only AF without clinical CHF (Group B). The 5 patients with CHF had a significantly lower mean age (36) than the 6 with thyrotoxicosis and AF only (P < 0.03). Echocardiography revealed Group A to have a mean of 2.8 cardiac chambers enlarged compared with a mean of 1 in Group B (P < 0.008). Four of the five patients with CHF had normal left ventricular function. Mean levels of serum thyroxine, albumin, hematocrit, left ventricular percent shortening, and left atrial diameter were similar in groups A and B. Based on the authors' data, thyrotoxicosis-induced CHF is not as rare a complication of thyrotoxicosis in young individuals as reported previously. Thyrotoxicosis-induced CHF most commonly has a dilated cardiomyopathy and high output failure.

Fluid and electrolyte replacement in the ultramarathon runner.

We studied three male runners during three separate ultramarathon races. Serial blood samples were tested for electrolytes, renal function, albumin, calcium, phosphorus, and magnesium. Two runners had aldosterone levels measured during the race and one runner had blood lactate levels measured. All runners ingested an isotonic fluid and electrolyte solution during the race. The runners consumed the solution without medical complications and maintained prerace body weights and hydration levels. Each runner maintained normal endocrine/metabolic parameters. We concluded that it is possible to maintain normal hydration and electrolyte states during a prolonged race, provided that sufficient fluid and electrolyte solutions are ingested.

Metabolic profiles in patients with acute neurosurgical injuries.

Twenty-seven patients with acute neurosurgical injuries were compared with 23 patients with neurosurgical and multisystem injuries and 10 patients with multi-system injuries without neurosurgical injuries. Patients with isolated acute neurosurgical injuries did not demonstrate a hypermetabolic state with increased loss of nitrogen and decreased circulating levels of albumin, prealbumin, and retinol-binding protein when compared to multisystem-injured patients. Patients with demonstrated hypermetabolism on day 1 were supported with parenteral nutrition which decreased their protein losses and stabilized other metabolic variables such as calcium and phosphorus. It is concluded that patients with neurosurgical and other multisystem injuries require close metabolic monitoring. Early institution of metabolic support in hypercatabolic patients may prevent clinically significant depletion states.

Prevalence of gallstones in obese Caucasian American women.

Although the association between gallstones and obesity is well known, no attempt has been made to quantitate the increased risk for gallstone formation associated with moderate obesity commonly seen in clinical practice. To determine the prevalence of both asymptomatic and symptomatic gallstones, screening oral cholecystograms were combined with prior documented history in 249 consecutive obese Caucasian women aged 20-59 yr who were seeking treatment for obesity in an out-patient clinic. To ascertain the relative risk of moderate obesity for gallstone formation, the results were compared with a control group of 60 consecutive women who were undergoing screening health examinations in the same clinic. Both groups were without gastrointestinal symptoms. Gallstone prevalence averaged 31 percent among obese women compared to 10 percent in the control group. Sixty percent of gallstones in the combined 20-29 yr age group were asymptomatic. However, among all patients with gallstone disease 59 percent had symptomatic disease evidence by prior cholecystectomy. Moderate obesity imposes at least a three-fold risk of gallstone disease in Caucasian women.

Immunologic status in severe obesity.

Aspects of humoral, secretory and cell-mediated immunologic status were studied in a group of 22 adults with severe, uncomplicated obesity. Normal concentrations of serum immunoglobulins (IgG, IgA, IgM, IgD) and complement components (C3, C4) were found. Levels of secretory IgA and lysozyme in the tears of obese patients did not differ from normal weight controls. The obese individuals had circulating sub-populations of T and B lymphocytes which were the same as controls. No effect of obesity was detected on the response of lymphocytes to stimulation in vitro with polyclonal T and B cell mitogens. All but two of the obese patients responded to one or more of the recall skin test antigens employed. We conclude that severe overweight alone, uncomplicated by diabetes or hyperlipidemia, is not associated with significant immunologic dysfunction.