Postmortem studies of the heart in three fatal cases of eosinophilia-myalgia syndrome

Article Abstract:

In 1989, an unusual illness developed in several people in New Mexico; investigators soon discovered the common feature that linked these cases was the use of L-tryptophan. L-tryptophan is a natural amino acid that serves not only as a building block of proteins, but also as the starting point for the biochemical synthesis of important chemicals in the brain. The substance was used as a dietary supplement among people suffering from insomnia, depression, and other disorders. Within a year, at least 27 people died of what is now referred to as eosinophilia-myalgia syndrome. A study was conducted of the heart tissues of three patients who died of this syndrome to determine if pathological features were present that might account for their sudden deaths. Several such features were identified. Numerous abnormalities were found in the arteries of the heart. Many arteries had a condition called fibromuscular dysplasia, an abnormal tissue buildup, which caused narrowing of the arteries serving the heart muscle. Considerable inflammation of the arteries was also observed, both in the lining and, in some cases, throughout the artery. Inflammation and pathological changes were not limited to the arteries, however. Inflammation was observed in the nerves of the heart, and similar inflammation was seen in the conduction system, which is responsible for distributing signals to maintain regular heart muscle contractions. Abnormalities of arteries were especially common within the heart conduction system. These abnormalities in the electrical conduction system, which controls the heart beat, may have played a key role in the demise of the patients. Similar abnormalities may also be present in living patients who are severely affected by eosinophilia-myalgia syndrome. Therefore, clinicians should be sensitive for signs of electrical instability in patients with eosinophilia-myalgia syndrome. Furthermore, in cases of sudden death, eosinophilia-myalgia syndrome should be considered as a possible cause, and inquiries should be made about the possibility of tryptophan use. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Complications and side effects, Heart, Pathological histology, Tryptophan, Eosinophilia-myalgia syndrome

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Partner violence, partner notification, and women's decisions to have an HIV test

Article Abstract:

Most women who refuse an HIV test do not necessarily do so because they fear a violent reaction to the test result from their male partner. However, in a study of 490 women at sexually transmitted clinics, 16% reported partner violence in the previous year.

Research, Women, Beliefs, opinions and attitudes, Family violence, Domestic violence

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Surveillance, social risk, and symbolism: framing the analysis for research and policy

Article Abstract:

The stigma attached to HIV infection illustrates why there is so much controversy over name-based HIV surveillance systems. A positive HIV test result can cause serious social and economic consequences for the individual.

AIDS (Disease), Disease reporting

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