To clarify the involvement of polyclonal activation of autoimmune reaction in organ-specific autoimmune diseases, we investigated the prevalence of nonthyroid specific autoantibodies in 50 patients with autoimmune thyroid diseases (22 patients with Graves' disease and 28 with Hashimoto's disease) and in 50 age- and sex-matched controls. None of the 100 subjects had any clinical manifestations or laboratory data indicating any other immunological, infectious, hepatic, or malignant diseases. The prevalence of positive antibodies to nucleus, smooth muscle, and single-stranded DNA in the patients (26%, 36%, and 34%, respectively) was higher than that in the control group (8%, 4%, and 4%, respectively), although neither group was positive for autoantibodies against double-stranded DNA, extractable nuclear antigen, SS-A, SS-B, mitochondria, or rheumatoid factor. Furthermore, 66% of the patients had at least one autoantibody to nucleus, smooth muscle, or single-stranded DNA. In conclusion, patients with autoimmune thyroid diseases show high prevalence of autoantibody against not only thyroid-specific, but also nonthyroid-specific antigens. These results are consistent with the concept that immune reaction of patients with organ-specific autoimmune diseases may be polyclonally accelerated to the production of antibodies against both organ and nonorgan specific autoantigens.

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Background:We report a heterozygous case of familial qualitative deficiency of antithrombin III associated with cerebral infarction.Case Description: A 33-year-old man had a history of recurrent transient ischemic attacks from the age of 28. Cerebral computed tomography at age 29 disclosed a low-density area in the left frontal lobe, and an internal carotid angiogram showed branch occlusion of the right anterior cerebral artery and stenosis of the left middle cerebral artery. Occlusion of the right middle cerebral artery developed thereafter. The plasma antithrombin III antigen concentration and progressive antithrombin activity were normal, but plasma heparin cofactor activity was low in the patient and his father. Nucleotide sequence analysis of the proband's deoxyribonucleic acid showed no mutation in exons II and VI of antithrombin III.Conclusions: We conclude that abnormal antithrombin HI with defective heparin binding, even though heterozygous, may cause ischemic stroke in young adults. We named this antithrombin III variant "Antithrombin III Nagasaki." (Stroke 1992;23:1822-1825 KEY WORDS • antithrombin III • cerebral infarction • hereditary disease • young adults

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Ventriculoperitoneal shunts (VPS) and gastrostomies are frequently provided in daily practice. This study investigated the incidence of VPS infection and the survival rate among adult patients who underwent gastrostomy at least 1 month after VPS placement. This single-center retrospective cohort study was conducted among patients with a VPS, who underwent a gastrostomy. This procedure was performed on a standby basis after a period of at least 1 month had elapsed since VPS placement. Subsequent VPS infection and survival rates were assessed over a period of at least 6 months. We reviewed 31 patients who had a VPS at the time of gastrostomy. Gastrostomy was performed endoscopically in 29 cases and via open surgery in 2 cases. The average interval between VPS insertion and gastrostomy was 1135.5 ± 1717.1 days. A single case of VPS infection (3.2%) was diagnosed during the study. This infection rate was not significantly different than that among 230 patients who underwent their first VPS placement (without gastrostomy) at our institution during the same time period (P = .57); there was also no significant difference in the survival rate, compared to 38 age-matched patients (with cerebrovascular disease, but without a VPS) who underwent gastrostomy (P = .73). Gastrostomy performed after an interval of at least 1 month after VPS placement was extremely safe in adult patients, and their prognosis was excellent. Additional studies are required to develop appropriate nutritional interventions for patients with a VPS.