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Atopic diathesis.

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Dermatitis, Atopic↗

The cluster diathesis.

We present further evidence for a sympathetic defect of vasomotor control of the anterior cerebral artery (ACA) on the side of the headache during cluster periods. In 119 cluster headache patients, utilizing transcranial Doppler, we measured CO2 reactivity of the major intracranial vessels, in and out of cluster. Reactivity was significantly lower during the cluster period, but only in the ACA on the side of the headache. Nineteen patients followed sequentially for a full cycle (ie/both in and out of a cluster period) showed the same changes. In 3 out of 6 patients in an active cluster period, we describe a lesion on Gallium single-photon emission computerized tomography (SPECT) in the region of the cavernous sinus which fades as the patient moves out of cluster. It is felt that this lesion may represent the cavernous sinus plexus lesion postulated as the central lesion in cluster. Changes in the sympathetic outflow at this point could explain the changes we have described in ACA CO2 reactivity during cluster.

Adult↗

Crime and the schizophrenia spectrum: a diathesis-stress model.

Previous studies support a relationship between schizophrenia and antisocial behavior. In the present study, offspring of schizophrenics showed a greater degree of antisocial behavior than did offspring of parents without psychopathology. The present study clarifies the interplay between risk for schizophrenia and developmental factors in determining antisocial behavior. Those variables which distinguished high-risk criminal behavior from high-risk non-criminal behavior were irritability and shortened attention span in infancy, paternal absence during ages 15 to 17, lower WAIS Verbal IQ, impoverished neighborhood, family discord and negative attitude towards father. In a multiple regression analysis, paternal absence in adolescence, shortness of attention span, and low Verbal IQ each contributed a unique portion of the variance in antisocial behavior. A block of interaction terms (Stressor X Risk) did not contribute a significant portion of the variance in antisocial behavior, suggesting that those factors which predict antisocial behavior in the high-risk group are the same factors which predict antisocial behavior in the low-risk group. In addition, a significant portion of the variance in phenotypic outcome (criminal vs. schizophrenic) was accounted for by passivity in infancy (predictive of schizophrenia) and low Verbal IQ (more common in high-risk criminals). Shortened attention spans in infancy were found to precede both criminal behavior and schizophrenia in this sample. This feature may therefore indicate a genetic vulnerability to schizophrenia.

Adult↗

Collagen and bleeding diathesis in Ehlers-Danlos syndrome.

There are at least 7 variants of Ehlers-Danlos syndrome (EDS). One family with type 1, one with type 3 and one isolated case with an undefined type of EDS are described. They all had bleeding symptoms, but surgery had been performed without complications. Collagen is believed to be defective in EDS. However, in our cases the platelet aggregating power of the collagen was normal. The bleeding time (Ivy) was slightly prolonged. Extensive examination of the haemostatic process revealed a decreased platelet adhesiveness in only 2 of the patients, a finding believed to be coincidental. The history of former operations on the patients and on affected relatives is considered to be the best guide in determining the risk of an operation, but preoperative estimation of the bleeding time is recommended.

Adolescent↗

LUPUS DIATHESIS.

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Allergy and Immunology↗

Prediction of haemorrhagic diathesis in thrombocytopenia by mean platelet volume.

The Coulter counter, model S Plus, Provides a platelet count and a mean platelet volume in all routine specimens of blood for cell count. The value of mean platelet volume in the prediction of the haemostatic potential of thrombocytopenic patients was investigated in 175 patients with haematological disorders who underwent 1473 blood counts over five months. Eighty-four haemorrhagic episodes were detected, most in thrombocytopenic patients. The mean platelet volume of patients with haemorrhagic tendency was significantly lower (5.52 +/- SD 0.7 fl) than that of patients without these tendencies (7.87 +/- SD 1.75 fl) (p less than 0.001). In cases of severe thrombocytopenia (less than 20 x 10(9)/1 platelets) haemorrhagic episodes were frequent; however, the frequency of bleeding was considerably lower in cases in which the mean platelet volume was higher than a suggested cut-off point of 6.4 fl. Discriminant analysis selected mean platelet volume as more important than platelet count for prediction of haemorrhagic state in severe thrombocytopenia. In view of the useful discrimination that mean platelet volume provides between thrombocytopenic patients who bleed and those who do not bleed, it may serve as a guide to predict the danger of haemorrhage and the need for prophylactic platelet transfusion.

Adolescent↗

Intra-abdominal adhesions as a manifestation of a fibrotic diathesis.

In 81 patients with fibrous intra-abdominal adhesions there was a high incidence of other lesions in which there was a substantial element of fibrosis. These included chronic peptic ulceration, ovarian cysts, fibrous stenotic lesions, and thickened scars. It is suggested that in some patients a generalized fibrotic tendency as well as local factors may play a part in the pathogenesis of adhesions.

ABO Blood-Group System↗

Coagulation factor concentrate in the treatment of the haemorrhagic diathesis of fulminant hepatic failure.

To assess the value of clotting factor concentrate infusions in fulminant hepatic failure, a controlled trial was performed in which nine patients were randomly allocated to treatment with either concentrate alone or concentrate plus heparin. The five patients receiving concentrate alone all died, with major bleeding as the direct cause of death in three, whereas in the four receiving heparin as well there was only one instance of bleeding and one patient survived. Clinical evidence of intravascular coagulation appeared in two patients treated with concentrate alone and the laboratory evidence of this progressed during the period of infusions in all patients in both treatment groups, although to a lesser extent in those receiving heparin. Additional evidence for intravascular coagulation came from the changes observed in factor VIII levels which, although initially high in all patients, fell subsequently, particularly in those given concentrate alone. There was some improvement in the prothrombin ratio in both groups of patients but not complete correction, and serial assays of clotting factors showed that although factor II rose to high levels during treatment, factors IX and X showed little response. Thus, the use of concentrate of factor IX in this trial, as well as potentiating intravascular coagulation, was inadequate as replacement for the clotting factor deficiencies.

Acute Disease↗