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Homocyst(e)ine refers to the sulfur-containing amino acids homocysteine, homocystine, and homocysteine-cysteine mixed disulfide, which normally exist in plasma in both the free and protein-bound forms. Marked hyperhomocyst(e)inemia is associated with well-recognized complications of occlusive thrombotic events and a characteristic syndrome. It is less clear whether mild to moderate elevations in plasma homocyst(e)ine concentrations (i.e., 1.5-5-fold increases) also represent a risk factor for stroke and, if so, whether it is independent of other recognized risk factors. To examine these questions we compared the plasma homocyst(e)ine levels in 41 patients with acute strokes, 27 patients with transient ischemic attacks, 31 patients with recognized risk factors for but no recent symptoms of cerebrovascular disease, and 31 normal volunteers (controls). Plasma homocyst(e)ine concentration was moderately but significantly higher in the patients than in the controls (/?<0.0001). Approximately 30% of the patients had homocyst(e)ine levels higher than the controls. No relation was found between homocyst(e)ine concentration and other recognized stroke risk factors or stroke type; however, a positive correlation was found between serum uric acid and plasma homocyst(e)ine levels. These data suggest that a moderately elevated plasma homocyst(e)ine concentration may be an independent risk factor for cerebrovascular disease. (Stroke 1990:21:572-576) H omocysteine, a thiol-containing amino acid derived from the metabolism of methionine, is readily oxidized in plasma to the disulfide homocystine and to homocysteine-cysteine mixed disulfide.1 All three chemicals occur normally in plasma in both the free and protein-bound forms and are collectively referred to as homocyst(e)ine. Brain infarction, carotid artery occlusion, and premature arteriosclerosis are well-recognized complications of marked hyperhomocyst(e)inemia caused by several inborn errors of metabolism including a deficiency of cystathionine /3-synthase. The characteristic clinical syndrome that accompanies this autosomal recessive trait manifests early in life, and most cases are recognized by adolescence. In this form of the disease, plasma levels of homocyst(e)ine are mark- edly elevated (usually >20 times normal) and there is associated homocystinuria. 1In contrast, mild to moderate elevations in homocyst(e)ine concentrations (approximately 1.5-5 times normal) are recognized in persons with partial reductions in cystathionine /3-synthase activity and those with nutritional deficiencies that influence the metabolism of methionine and homocysteine. Recent studies suggest that these individuals may be at increased risk for developing the complications of arteriosclerotic cardiovascular and peripheral vascular disease, including stroke.2 -4 Among 36 subjects (19 with atherosclerotic cerebrovascular disease [CVD]), Brattstrom et al 5 found moderate elevations in plasma mixed disulfide concentrations in a significant proportion of cases with CVD. Although the authors arg...

SUMMARYBackground: Available prospectively acquired data on the distribution of oesophageal motor abnormalities in patients being evaluated for non-cardiac chest pain and/or dysphagia are relatively scarce. Aim: To evaluate the distribution of oesophageal motor abnormalities in patients with dysphagia, non-cardiac chest pain or both using the national Clinical Outcomes Research Initiative (CORI) database. Methods: The CORI oesophageal motility database originates from 19 community, university and VA medical centres. Data were collected using a computerized motility report-generating program, combined with the CORI module. Data from each site were encrypted and sent to the CORI National Repository for analysis. The database includes the assessment of the lower and upper oesophageal sphincter function and the motor activity of the oesophageal body. Results: Five hundred and eighty-seven consecutive patients who underwent motility studies between 1998 and 2001 were included in the CORI database and analysed for this report. Four hundred and three patients (69%) had dysphagia as their primary indicator for the examination, 140 patients (24%) had non-cardiac chest pain and 44 patients (7%) had