Essential fatty acids and phospholipase A2 in autistic spectrum disorders.

A health questionnaire based on parental observations of clinical signs of fatty acid deficiency (FAD) showed that patients with autism and Asperger's syndrome (ASP) had significantly higher FAD scores (6.34+/-4.37 and 7.64+/-6.20, respectively) compared to controls (1.78+/-1.68). Patients with regressive autism had significantly higher percentages of 18:0,18:2n-6 and total saturates in their RBC membranes compared to controls, while 24:0, 22:5n-6, 24:1 and the 20:4n-6/20:5n-3 ratio were significantly higher in both regressive autism and ASP groups compared to controls. By comparison, the 18:1n-9 and 20:4n-6 values were significantly lower in patients with regressive autism compared to controls while 22:5n-3, total n-3 and total dimethyl acetals were significantly lower in both regressive autism and ASP groups compared to controls. Storage of RBC at -20 degrees C for 6 weeks resulted in significant reductions in highly unsaturated fatty acid levels in polar lipids of patients with regressive autism, compared to patients with classical autism or ASP, or controls. Patients diagnosed with both autism and ASP showed significantly increased levels of EPA ( approximately 200%) and DHA ( approximately 40%), and significantly reduced levels of ARA ( approximately 20%), 20:3n-6 and ARA/EPA ratio in their RBC polar lipids, when supplemented with EPA-rich fish oils, compared to controls and non-supplemented patients with autism. Patients with both regressive autism and classical autism/Asperger's syndrome had significantly higher concentrations of RBC type IV phospholipase A2 compared to controls. However, patients with autism/ASP, who had taken EPA supplements, had significantly reduced PLA2 concentrations compared to unsupplemented patients with classical autism or ASP.

Increased levels of cytosolic phospholipase A2 in dyslexics.

Research findings are increasingly reporting evidence of physiological abnormalities in dyslexia and sites for dyslexia have been identified on three chromosomes. It has been suggested that genetic inheritance may cause phospholipid abnormalities in dyslexia somewhat similar to those found in schizophrenia. A key enzyme in phospholipid metabolism, Type IV, or cytosolic, phospholipase A2 (cPLA2), releases arachidonic acid (AA), a 20-carbon fatty acid, which is the major source of production of prostaglandins and leukotrienes. An entirely new assay, which for the first time has enabled determination of the amount of the enzyme rather than its activity, was used to measure cPLA2 in dyslexic-type adults and controls and the two groups were found to differ significantly, the dyslexic-types having more of the enzyme. A report elsewhere of schizophrenics having even greater amounts of the enzyme suggests that dyslexia may be on a continuum with schizophrenia, as may be other neurodevelopmental disorders - which have also been described as phospholipid spectrum disorders.

Troponin I and myocardial injury in the ICU.

Cardiac troponin I (cTnI) is a protein that is specific to heart muscle. Increased concentrations appear in serum after myocardial cell injury. cTnI was compared with creatinine kinase MB (CK MB), myoglobin and the 12-lead ECG for detection of myocardial injury in an unselected series of 109 medical and surgical ICU patients. Clinical observations and daily 12-lead ECG were recorded prospectively. Samples for cTnI, myoglobin and CK MB serum analysis were collected each day. Increased serum cTnI concentrations (> 0.1 microgram litre-1) were observed in 70.6% (n = 77) of the ICU group. Tachycardia, arrhythmia, hypotension and treatment with inotropic drugs were associated with higher concentrations. The standardized mortality ratio by APACHE III for the ICU sample was 0.98. All subjects in an unmatched control group of 98 medical unit emergency admissions without a primary cardiac diagnosis had serum cTnI concentrations < 0.1 microgram litre-1. We conclude that increased serum cTnI concentrations occur frequently in the ICU suggesting that there is a high incidence of cardiac injury in these patients.

Transient 5-oxoprolinuria (pyroglutamic aciduria) with systemic acidosis in an adult receiving antibiotic therapy.

5-Oxoprolinuria is a recognized condition with increased urinary excretion of 5-oxoproline and is associated with a variety of inborn metabolic defects involving the series of enzyme-linked reactions known as the gamma-glutamyl cycle. We report the unusual case of a 35-year-old woman who initially presented with staphylococcal pneumonia but went on to develop a transient high anion gap metabolic acidosis. The development and subsequent complete recovery from this acidosis were subsequently shown to be related in time to the intravenous administration of the antibiotics flucloxacillin and netilmicin. Analysis of the patient's urine for organic acids revealed massively increased excretions of 5-oxoproline at the peak of her acidosis. We suggest that this patient developed a transient disturbance in the gamma-glutamyl cycle involving the 5-oxoprolinase step, which resulted in accumulation of 5-oxoproline that caused a severe high anion gap metabolic acidosis. The administered antibiotics remain as possible causative agents.

Early diagnosis of acute myocardial infarction: CK-MB and myoglobin compared.

We have measured changes in plasma concentration of creatine kinase MB (CK-MB) and myoglobin in 50 patients admitted to the Coronary Care Unit with chest pain of presumed cardiac origin. Eight serial blood samples were obtained in the 6 h period following admission and both CK-MB and myoglobin concentrations were measured. We compared the performance of single values of both tests. Myoglobin concentration, in the coronary care population studied, proved to be as specific as CK-MB concentration (92.6% in both cases) but with sensitivity of 100% being achieved 1.5 h post admission rather than 4 h post admission in the case of CK-MB. On this evidence, measurement of plasma myoglobin could prove useful in the rapid diagnosis of myocardial infarction with consequent effects on optimal Coronary Care utilisation and selection of patients for thrombolytic therapy.

Hyperemesis gravidarum and thyrotoxicosis--a diagnostic and therapeutic problem.

We report a case of hyperemesis gravidarum complicated by thyrotoxicosis which was managed conservatively during pregnancy. Problems of diagnosing mild thyrotoxicosis in pregnancy are discussed. Although no specific antithyroid therapy was given, the patient had an uneventful pregnancy after the first trimester. Neither she nor her baby exhibited any subsequent features of thyroid dysfunction. This suggests that treatment of thyrotoxicosis in early pregnancy is not always required because of the spontaneous improvement which is likely to occur as pregnancy progresses.

Hospital and community health service costs: England and Scotland compared.

In publications which have compared the health expenditure in the component parts of the United Kingdom by applying the Resource Allocation Working Party (RAWP) formula to the health budget of England, Scotland, Wales, and Northern Ireland it has been previously concluded that Scotland's hospital and community health services expenditure is more than 19% above what would be a fair distribution. It has also been implied that Scotland's allocation should be cut substantially to improve services in England. On the assumption that the purpose of examining the distribution of the health and community health service budget is to ensure "equal opportunity of access to health care for people at equal risk" it is concluded that simple RAWPing of the United Kingdom budget is flawed and a conclusion based on this is therefore untenable.

Can thyroid stimulating hormone levels by TSH (IRMA) predict relapse of thyrotoxicosis following carbimazole treatment?

Serum thyrotrophin receptor antibody (TRAb) and thyroid stimulating hormone (TSH) (IRMA) levels were measured in 38 patients at one month after the end of a course of carbimazole/T3 therapy for Graves' disease. Despite the increased sensitivity of the IRMA assay a TSH measurement at this stage was found to be of no predictive value, in contrast to estimation of serum TRAb levels which correctly predicted relapse and remission in 90% of patients.

Enzyme immunoassay for pregnancy-associated plasma protein-A.

This enzyme immunoassay procedure for pregnancy-associated plasma protein type A involves a "sandwich"-type system in microtitration plates. One can detect 0.27 mg of the protein per liter of serum, with a between-batch CV of 10.2%, and the antiserum used does not cross react with any of the other placentally derived proteins. A reference interval for the last trimester of pregnancy is presented. The procedure described is suitable for studying the behavior of this protein during pregnancy.