Yehuda L. Danon

BIRTH WEIGHT, CURRENT BODY WEIGHT, AND BLOOD PRESSURE IN LATE ADOLESCENCE

Objective--To study the effect of birth weight and body weight on blood pressure in late adolescence. Design--Analysis of data on weight, height, and blood pressure at age 17 of subjects from the Jerusalem perinatal study, according to their birth weight. Data for men and women were analysed separately. Setting--Jerusalem, Israel. Subjects--32,580 subjects (19,734 men and 12,846 women) born in the three major hospitals in Jerusalem during 1964-71 and subsequently drafted in to the army. MAIN OUTCOME MEASURES--Correlations between birth weight and blood pressure at age 17 and weight and height at age 17 and blood pressure. Results--Diastolic and systolic blood pressures were associated with birth weight in both young men and young women, but the correlation coefficients were low. A high body weight at age 17 (greater than 66 kg for women, greater than 75 kg for men) rather than a low birth weight (less than 2500 g) was linked with higher systolic and diastolic blood pressures in both men and women (p less than 0.01). Conclusions--Intrauterine environment, as reflected by birth weight, has little effect on blood pressure in young men and women. Modification of factors which lead to excess weight during adolescence may have a major role in preventing hypertension in adults.

The cognitive outcome of full-term small for gestational age infants at late adolescence

Objective To assess the cognitive and academic performance of adolescents who were born small for gestational age (SGA) at term. Methods A 17-year historical prospective study was done by matching neonatal data of 1758 infants to the results of the medical and intelligence assessment performed at age 17 years at the army draft board medical examination in Israel. The results of children born SGA (weight at term birth below the third percentile) were compared to those of children who were born appropriate for gestational age (AGA). Results After adjustment by a multiple linear regression analysis, the mean (± standard error of the mean) intelligence test scores were 103.1 ± 2.9 versus 105.8 ± 1.5 (P = 0.3) for the males and 100.3 ± 2.5 versus 104.7 ± 1.6 (P < .03) for the females. Males born SGA at term were found to have lower educational achievements (having less than 12 years of schooling or attending a vocational school) compared with the AGA group. The odds ratio for this finding after adjustment by a logistic regression analysis was 2.40 (95% confidence interval 1.07–5.39; P < .03). Intranatal events were not found to have an effect on the measured neurodevelopmental outcome. Conclusion Infants born SGA at term have an increased risk for lower cognitive performance and schooling achievements than those born AGA; this result seems to be unrelated to their intranatal course.

Is low birth weight a risk factor for asthma during adolescence

The effect of low birth weight on the incidence of asthma by 17 years of age was investigated by studying medical draft examination records of 20,312 male subjects born in Jerusalem between January 1967 and December 1971. Additional information on birth weight and other demographic factors was abstracted from the Jerusalem Perinatal Study computerised database. A stepwise multiple logistic regression was used to estimate the odds ratios for developing asthma by 17 years of age in 500 g birthweight categories from less than 2000 g to 4500 g. The odds ratios were adjusted for the confounding effects of ethnic origin, social class (determined by area of residence), paternal education, maternal age, and birth order. The group with low birth weights (less than 2500 g, n = 1004) had a significantly increased risk of developing asthma by 17 years of age, with an adjusted odds ratio of 1.44 (95% confidence interval (CI) 0.79 to 2.66) for birthweight group less than 2000 g and 1.49 (95% CI 1.05 to 2.12) for birthweight group 2000-2499 g compared with the reference group of 3000-3499 g. We conclude that infants with birth weights of less than 2500 g may have a higher risk of asthma during childhood and adolescence than infants who were heavier at birth.

Childhood asthma and growth outcome.

To study the ultimate growth variables of children with asthma we analysed the military medical records of 54,041 boys and 38,102 girls at the age of 17 years. History of asthma was found in 2252 boys and 1158 girls, who were then categorised according to three grades of severity. Analysis of their growth was made separately for each sex and for each grade of severity of clinical disease. Boys who suffered from mild asthma that subsided before adolescence were significantly taller, heavier, and fatter than their respective controls. There was a slight decrement in all three growth variables in correlation with increased severity. The most severely affected patients had retarded height and weight in comparison with the mildly affected children, but the differences were not significant. The same tendency was found in the girls. Children with asthma will ultimately reach normal height and weight. Those who are mildly affected tend to be even taller and heavier than adolescents without asthma. The severity of the asthma influences final growth.

Cerebrospinal fluid leukocyte aggregation in meningitis.

OBJECTIVEnTo evaluate whether the difference in aggregation of cerebrospinal fluid cells from patients with bacterial, viral, aseptic and partially treated meningitis can be used for diagnostic purposes.nnnMETHODSnCerebrospinal fluid samples of 100 patients with meningitis (15 bacterial, 13 partially treated, 10 viral and 62 aseptic) were compared on the basis of the predefined leukocyte aggregation score (LAS).nnnRESULTSnMean LAS was 56% in the bacterial meningitis group (range, 15 to 90%), 5.8% in the partially treated meningitis group (range, 0 to 27%), 2% in the proven viral meningitis group (range, 0 to 5%) and 2% in the aseptic meningitis group (range, 0 to 15%). All patients with bacterial meningitis had a LAS of > 15%, whereas all those with viral or aseptic meningitis had a score of < 15%. Although most patients with partially treated meningitis had a low LAS, several had higher scores, which may indicate bacterial infection. There was no statistical correlation between number of cells, type of cells (mononuclear or polymorphonuclear) or cerebrospinal fluid protein and glucose concentration and degree of leukocyte aggregation for the different groups.nnnCONCLUSIONnMeasurement of the LAS may contribute to the immediate differential diagnosis of bacterial or viral meningitis, especially in patients with very high pleocytosis, as sometimes seen in enteroviral meningitis. It may also serve as a guide for the likelihood of bacterial infection in cases of partially treated meningitis. Additional studies are needed to confirm these observations.

Effect of valvular heart diseases, migraine headaches, and perianal diseases on the risk of involvement in motor vehicle crashes

Impaired health can interfere with driving performance. We have launched this investigation to identify in professional military drivers health parameters that might be associated with involvement in motor vehicle crashes (MVCs). All Israel Defense Forces professional male drivers (N = 5,605) conscripted into compulsory military service between April 1, 1988 and April 1, 1990 were divided into two groups according to whether (N = 1,300) or not (N = 4,305) the driver was involved in MVCs during the same time frame. Using the multivariate Cox model, a significant association was shown between involvement in MVCs and the following health parameters: mild-to-moderate valvular heart disease (p = 0.0002, chi 2 = 13.89), migraine headaches (p = 0.009, chi 2 = 6.91), and perianal diseases (p = 0.006, chi 2 = 7.44). We hypothesize that interference with the drivers performance level may be a result of the discomfort associated with those clinical conditions. It is possible that interference with the personal performance level decreased the ability of the driver to cope with the specific driving task demands and resulted in the involvement of the driver in MVCs. We suggest that because of the high social and economic costs associated with road accidents, it is important to investigate further the association of involvement in MVCs and health problems. If our findings are confirmed in the future studies, intervention programs to reduce MVC rates would be suggested and conducted among professional drivers.

Fatal Accidental Inhalation of Bromochlorodifluoromethane (Halon 1211)

Bromochlorodifluoromethane (Halon 1211) is a widely used fire extinguishing agent. Several cases of sudden death in teenagers associated with BCF abuse have been reported. BCF is used as a fire extinguisher in battle tanks. Two young previously healthy male soldiers were accidentally exposed to BCF in a battle tank. The tank driver died, but the gunner survived the event with no medical complications. It is concluded that BCF should be used in confined chambers only after the evacuation of all personnel.

Lymphocyte subpopulations in children with abnormal lymphatic circulation

Peripheral blood lymphocyte subsets were enumerated in five children with abnormal lymphatic circulation (three with lymphangiectasia, one with chylothorax, and one child with chyloperitoneum). All patients were lymphopenic. The percentage and absolute number of blood T-lymphocytes (CD3) were low in two children and normal in the other children. The percentage and absolute number of helper/inducer lymphocytes (CD4) were markedly reduced in all patients. The percentage of suppressor/cytotoxic lymphocytes (CD8) was normal or elevated in all children, and the absolute number of CD8 cells was normal in three patients. The CD4/CD8 ratio was reversed in all patients. In the two patients tested, the proliferative response of peripheral blood mononuclear cells to mitogens was reduced. T-lymphocyte subsets were measured in the pleural or peritoneal fluid of three patients, and the CD4/CD8 ratio was normal or increased. In each child, the CD4/CD8 ratio in the lymphatic fluids was markedly higher than the CD4/CD8 ratio of the blood (4.0/0.45, 1.75/0.95, and 1.3/0.85). The reversed CD4/CD8 ratio in the blood in cases of chronic loss of chyle may be due to either selective transport of CD4 lymphocytes into the lymphatic fluids or a shorter half-life of CD8 compared to CD4 lymphocytes. This finding may in part explain the abnormal cellular immunity previously observed in patients with lymphangiectasia.

Erythema Multiforme and Hypersensivity Myocarditis Caused by Ampicillin

OBJECTIVE: To report a case of erythema multiforme and hypersensitivity myocarditis caused by ampicillin. CASE SUMMARY: A 13-year-old boy was treated with ampicillin and gentamicin because of suspected septicemia. Medications were discontinued when erythema multiforme and congestive heart failure caused by myocarditis occurred. The patient was treated with methylprednisolone and gradually improved. Macrophage-migration inhibition (MIF) test with ampicillin was positive. DISCUSSION: After most infections causing erythema multiforme and myocarditis were ruled out, a drug-induced allergic reaction was suspected. Positive MIF test for ampicillin showed sensitization of the patients lymphocytes to ampicillin. CONCLUSIONS: Hypersensitivity myocarditis is a rare and dangerous manifestation of allergy to penicillins.

Dental Caries in Children with Chronic Idiopathic Urticaria in Israel

Most cases of chronic urticaria in children are idiopathic. Chronic focal infections of the sinuses or oral cavity have been mentioned as a cause of chronic urticaria because of the persistent antigenic stimulation. To investigate whether children with chronic idiopathic urticaria (CIU) have a higher prevalence and total experience of dental caries than other children in Israel, oral examination was performed to determine decay, missing, filled-teeth (DMFT) scores in 25 children with CIU (mean age, 11.76 ± 3.84 years) and 50 children with perennial allergic rhinitis (PAR) (mean age, 12.57 ± 3.29 years). The results of both groups were compared with reference data from another study on 12-year-old schoolchildren in Israel (n = 762). DMFT scores were 2.84 ± 3.18 in the CIU group, 1.56 ± 1.77 in the PAR group (p = 0.07), and 2.99 ± 2.7 in the reference group (p = 0.80). The difference between the PAR and reference groups was statistically significant (p = 0.001). Twenty-eight percent of the children with CIU...