Comparative study of tear substitutes and their immediate effect on the precorneal tear film.

Dry eye patients present with instability of the precorneal tear film which breaks up much earlier than normally. The instability of the precorneal tear film leads to dry eye symptoms such as the sensation of sand in the eye, recurrent blurred vision, itching, smartness, and the sensation of dryness. The stability of the precorneal tear film can be evaluated by the break-up-time test (BUT). The aim of treatment of dry eye is to increase the precorneal tear film stability. Tear substitutes are the most frequent medication for dry eye patients, who request life-long treatment. Therefore, we estimated the influence of tear substitutes on the precorneal tear film stability. The influence of unpreserved artificial tear substitute containing 0.1% sodium hyaluronate (Healon 0.1%) was compared with that of 7 different available tear substitute preparations containing preservatives. The results of the present study show that Healon 0.1% has the best influence on the precorneal tear film stability. These data were found to be independent of the viscosity property of Healon 0.1%.

Plasma fibrinogen in Israeli Moslem and Jewish school-children: distribution and relation to other cardiovascular risk factors. The Petah Tikva project.

Plasma fibrinogen levels were measured in 1,175 Israeli schoolchildren, aged 9-18 years, originating from diverse ethnic groups. The Moslem children displayed striking differences in levels and age-patterns of fibrinogen compared to Jewish children. Lower mean plasma fibrinogen levels in boys aged 9-10, 13-14 and 16-18 were observed among Moslem boys, compared to their Jewish counterparts born in Israel. Moslem girls showed lower levels of fibrinogen than Jewish Israeli girls at ages 9-10 and 16-18. While the Jewish children displayed an age-associated fibrinogen pattern comparable at the three age groups, the levels for Moslem children increased pre-puberty and decreased post-puberty, peaking at 13-14 years. No significant difference in mean plasma fibrinogen was found between sexes within ethnic groups. A number of statistically significant but low correlations (-0.32 to 0.24) were found between plasma fibrinogen and high density lipoprotein cholesterol (HDL-C) as a percentage of total cholesterol, triglycerides, blood glucose, uric acid, blood pressure, Quetelet index and sports activity. The difference between fibrinogen levels might point to a possible ethnicity risk factor explanation rather than environmentally acquired factors.

Tissue plasminogen activator levels in different types of polycythemia.

The plasma level of tissue plasminogen activator antigen (t-PA-Ag) was examined in 86 patients with polycythemia (29 polycythemia vera, 11 secondary polycythemia and 46 with spurious polycythemia) and 24 healthy volunteers. Tissue plasminogen activator antigen was significantly decreased in patients with polycythemia vera in comparison with healthy controls. On the other hand, in patients with spurious polycythemia and secondary polycythemia t-PA-Ag concentration was significantly increased. There was no significant difference in t-PA-Ag levels in polycythemic patients with or without thromboembolic disease. A significant correlation was detected between t-PA-Ag level and hemoglobin or hematocrit concentration in patients with polycythemia vera (p = 0.02, r = 0.43). However, in patients with secondary polycythemia and spurious polycythemia, no significant correlation between t-PA-Ag and hemoglobin level was found. Plasminogen activator inhibitor (PAI) levels in patients with polycythemia vera and healthy volunteers did not differ significantly.

[Hyperviscosity syndrome and eye involvement].

10 patients with serum hyperviscosity syndrome of different etiologies were examined by fluorescein angiography of the ocular fundus. There was no exact correlation between the pathological findings in the fundus of cases with plasma cell dyscrasia and blood viscosity. Only papilledema and retinal venous engorgement were improved by lowering serum viscosity by plasmapheresis. The abnormal circulating immunoglobulins are an important factor in the genesis of the pathological changes in the retina of patients with plasma cell dyscrasia.

Tuberculosis of the middle ear in an infant.

Tuberculosis of the middle ear is currently a rare disease. As most physicians are unfamiliar with the typical presenting features, the diagnosis is made too late, with resulting complications, such as irreversible hearing loss and facial nerve paralysis. A case report and review of the literature are presented, emphasizing that tuberculosis should be considered in the differential diagnosis of chronic ear infection.

Pleomorphic adenoma arising in accessory salivary tissue with constriction of Stensen's duct.

Accessory salivary gland tissue is well recognized and is found in 21 per cent of the population. Tumours of the accessory salivary tissue are rare and comprise only 1 per cent of all parotid gland tumours. A pleomorphic adenoma of Stensen's duct is described. A circular constriction of this duct by the tumour with retention of saliva in the parotid gland was observed.

The in vitro effect of pirprofen on the surface ultrastructure and function of human platelets.

The in vitro effect of pirprofen (Rengasil), an antiinflammatory agent, on the surface ultrastructure and function of human platelets was examined and compared with that of acetylsalicylic acid (Aspirin, ASA), and diclofenac sodium (Voltaren, DS). Incubation with pirprofen induced formation of long, needle-shaped pseudopodia, a phenomenon observed also after incubation of the cells with DS. In contrast with ASA and DS, pirprofen induced a marked increase in platelet protein synthesizing capacity. The drug decreased the platelet aggregation to a degree similar to that of ASA and DS. The release of platelet factors 3 and 4 and the level of beta-thromboglobulin following incubation with the drug remained unaltered.

Male fertility in factor XIII deficiency.

Seven homozygotes for F-XIII deficiency were found in a large inbred Israeli-Arab kindred. One affected woman had early abortions. Two affected men and one probably affected man had children, two of whom also were affected. Paternity was confirmed by segregation of HLAs and erythrocyte antigens and enzymes. This is the first documentation of normal male fertility in unequivocally affected patients. Clinical variability or genetic heterogeneity may account for previously reported male infertility.

Rectal bleeding induced by Dipyridamole.

Nineteen patients treated continuously with Dipyridamole were evaluated for rectal bleeding. Thirteen suffered from overt rectal bleeding and six served as controls. Hemorrhoids were found in all patients. Contact bleeding was found in 16. The bleeding continued despite rubber band ligation, and stopped only on withdrawal of the drug.

Hemostatic changes after saline infusion.

An in vitro trial was performed to detect a thrombotic tendency in patients receiving saline infusions before surgery. The following tests were performed: thromboelastography (TEG) with the three indices of the reaction time (r), clot formation time (k) and maximum amplitude (MA), and antithrombin III, which was investigated immunologically as well as by a functional test with a chromogenic substrate and an automated method. The use of these tests together with others for the detection of high-risk patients is suggested, since no single laboratory test was found to be sufficient for the prediction of thrombotic diseases.

Neonatal factor XIII deficiency.

We describe a patient diagnosed in the neonatal period as having factor XIII deficiency who presented with persistent umbilical bleeding. Factor XIII deficiency is the only coagulation factor deficiency that cannot be detected by classical hemostatic tests, and a rapid diagnosis is vital during the first decade of life. A newborn presenting with persistent umbilical stump bleeding should be screened for factor XIII deficiency when routine coagulation tests prove normal.

Platelet X-ray microanalysis in patients with chronic renal failure.

The platelet element content was determined by semiquantitative X-ray microanalysis in 6 patients with chronic renal failure. The patients showed a different degree of thrombocytopathy expressed by impaired adhesiveness, epinephrine-induced aggregation and platelet factor 3 availability. The microanalysis indicated significantly increased quantities of phosphorus and copper in patients' platelets. Sodium and zinc showed a decrease in about half of the patients, whereas iron was significantly increased in at least 50% of the patients. Magnesium and potassium did not show any difference from the control. The results of sulfur, chlorine and calcium did not reveal a consistent pattern.

The kinin system in exercise-induced asthma.

Seventeen asthmatic children, nine with and eight without exercise-induced asthma (EIA), and nine control non-asthmatic children were studied in an attempt to discern possible associations between the activity of the kinin system and EIA. Pulmonary function tests and clinical check-up were performed before and after 6 min of free-range running. Concomitant blood tests revealed a consistent elevation of the kallikrein levels following the exercise challenge in all experimental groups. However, only in the EIA positive group did this elevation exceed the normal laboratory range (16 +/- 7.0 mu/ml). Prekallikrein levels both before and after exercise did not exceed in any group the normal laboratory values. The findings thus suggest that provocation of EIA is associated with a certain threshold of kallikrein level below which no such symptoms are observed. EIA may be triggered only when kallikrein levels are in excess.

Thromboembolism in congenital factor VII deficiency.

An Israeli family of Persian origin was investigated for factor VII deficiency. The proposita, derived from a consanguineous marriage, had repeated thrombophlebitis attacks, pulmonary embolism and rectal bleeding. The family studied and the proposita had low factor VII procoagulant activity and low factor VII antigen.

Hyperreactivity to bee stings: reevaluation.

(a) A survey of beekeepers in Israel did not show that they differed allergy-wise from the general population. (b) Twenty-eight non-beekeeper systemic reactors to bee stings were not necessarily more allergic or more exposed to stings than the others. These systemic reactors had a spontaneous kinin system hyperreactivity and in some of them changes in the immune system and a complement defect were detected. We think that predisposition may enhance the likelihood of a systemic reaction to bee stings. Thus the common denominator for the hyperreactivity to bee stings is not their exposure to stings nor their allergic background but rather the spontaneous kinin activity and a possible defect in their immunological system.