Assessment of nonarticular tenderness and prevalence of fibromyalgia in children

Fibromyalgia syndrome (FS) is most common in midlife, but may be seen at any age. Its prevalence and assessment of tenderness in healthy children is not known. We assessed 338 healthy schoolchildren for tenderness thresholds and prevalence of FS. In all children a point count of 18 tender points (TP) was conducted by thumb palpation and tenderness of some of the TP sites as well as control point sites was further assessed using a Chatillon dolorimeter. All children and their parents were questioned about the presence of widespread pain or aching. Children were considered to have FS if they met the American College of Rheumatology (ACR) criteria for diagnosis of FS. Of the 338 children, 21 (6.2%) had FS. Thresholds of tenderness of 9 TP were 5.0 (1.2) (kg) [mean (standard deviation)] for boys vs 3.6 (0.8) (kg) for girls (p < 0.001). Thresholds of tenderness of the control point sites were 7.1 (1.4) (kg) for boys vs 5.5 (1.1) (kg) for girls (p < 0.001). Thresholds of tenderness of TP and control points in the children with FS were 2.5 (0.4) (kg) and 4.2 (0.5) (kg) vs 4.5 (1.2) (kg) and 6.6 (1.4) (kg) respectively in the children without FS (p < 0.001). We suggest that FS is common in the pediatric age group. Boys have lower tenderness than girls; children with FS have lower thresholds for tenderness both at control and TP compared to the subjects without FS.

Functional coupling of neonatal rat Sertoli cells and gonocytes in coculture

Interaction between Sertoli cells and germ cells is likely to be critical for normal development of the testis. We have established and characterized cocultures of neonatal Sertoli cells and gonocytes and have begun to study the physical and functional relationship between these cells in vitro. Cells were isolated from rat pups by sequential enzymatic treatment and cultured in serum-free medium. When plated on Matrigel, Sertoli cells rapidly attach, and gonocytes adhere to the underlying Sertoli cells shortly thereafter. We observed that some of these germ cells develop cytoplasmic processes and elongate during the first day of culture, essentially mimicking their behavior in vivo. Electron microscopic examination of typical cultures revealed the presence of desmosome-like adhesion sites and apparent gap junctions between Sertoli cells and gonocytes. To determine whether Sertoli cells and gonocytes are functionally coupled in the cocultures, we used the glass bead-loading technique of McNeil and Warder to introduce Lucifer yellow (LY), a gap junction-permeant probe, and Rhodamine-dextran (RD), a larger marker excluded by gap junctions, simultaneously into cultures 24 h after plating. Immediate fixation and viewing of cultures with fluorescence microscopy indicated that all bead-loaded cells received both probes. We studied other living cultures 10 min after bead-loading and located RD-negative (i.e. nonbead-loaded) gonocytes that were in obvious contact with RD- and LY-positive bead-loaded Sertoli cells; these gonocytes were scored for the presence or absence of cytoplasmic LY. This analysis revealed that many gonocytes were able to obtain LY from adjacent Sertoli cells, presumably via gap junctions maintained with these cells. In addition, we quantified the percentage of gonocytes that elongated with increasing time in vitro and correlated the morphology of these cells with their ability to acquire LY from adjacent Sertoli cells. Our findings indicate that although the absolute numbers of gonocytes present decreases, more of those remaining elongate as time in vitro increases. We can also conclude from our data that gonocytes with and without processes are equally likely to be coupled with Sertoli cells under these conditions. These observations provide the first demonstration of functional coupling between Sertoli cells and premeiotic germ cells. Together with our morphological observations, they suggest that gap junction-mediated communication between these cells may be involved in stimulating or regulating changes in the gonocyte population during postnatal development of the testis.

Endorphin suppresses FSH-stimulated proliferation of isolated neonatal Sertoli cells by a pertussis toxin-sensitive mechanism

During perinatal development, when the size of the Sertoli cell population is determined, Leydig cells produce beta-endorphin, a peptide which may interact with Sertoli cells to modify their FSH-responsiveness, as suggested by our previous work. The goal of the present study was first, to test directly the possibility that beta-endorphin modifies the proliferative response of neonatal Sertoli cells to FSH, and second, to gain information on a mechanism(s) involved in any observed effect. We treated isolated 6-day-old Sertoli cells with FSH or vehicle in vitro and measured their incorporation of exogenous, radiolabeled thymidine with quantitative autoradiography. After 2 days in culture with FSH, we detected a 10-fold increase in the rate of Sertoli cell proliferation. The level of cell division in these FSH-treated cultures was identical to that in other cultures exposed to cAMP under similar conditions. In addition, inclusion of beta-endorphin 3 hr prior to FSH or cAMP decreased the effect of the hormone by 50% but left the cAMP response unchanged. Thus, beta-endorphin acts on isolated, neonatal Sertoli cells at a point prior to intracellular production of cAMP to suppress their response to FSH. When other cultures were treated with pertussis toxin, a blocker of intracellular GTP-binding proteins such as Gi, before sequential addition of endorphin and FSH, the effect of beta-endorphin on FSH-responsiveness was abolished. Moreover, when other cultures were exposed to pertussis toxin in the absence of endorphin, followed by FSH, their response to the hormone was unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assessment of diabetic autonomic neuropathy by heart rate monitoring]

Assessment of diabetic autonomic neuropathy in a representative sample of 91 noninsulin-dependent diabetics was performed in 3 community clinics. A difference of less than 10 beats/min in heart rate between deep inspiration and deep expiration determined by ECG recording served as the criterion for autonomic neuropathy. By this test, 86% of the patients had diabetic autonomic neuropathy, a slightly higher proportion than that reported by others using similar criteria in more selected populations. The test is very sensitive and can be used for screening.

Influence of prolonged submaximal exercise on the pharmacokinetics of verapamil in humans

The influence of prolonged submaximal exercise on the pharmacokinetics of verapamil was studied in normal volunteers both after i.v. injections of 0.13 mg/kg body weight as well as after one oral dose of 80 mg of the calcium entry blocker. Each dose was given on a rest day and on an exercise day. On the rest day, the terminal phase half-life (t1/2) of verapamil averaged 161 +/- 23 min after i.v. injection of the drug. The total clearance was 772 +/- 125 ml/min, and the area volume of distribution was 198 +/- 53 L. These parameters were not altered on the exercise day. Neither did exercise have any influence on the pharmacokinetic parameters determined after oral application of verapamil. This study shows that prolonged submaximal exercise has no influence on the pharmacokinetics of verapamil.

Severe multicore disease associated with reaction to anesthesia

Multicore disease is a nonprogressive myopathy. To our knowledge, in all previous cases, the clinical course has been benign with no deaths attributed to it. We describe a patient who presented as a floppy baby and remained weaker throughout his life than any other patients previously described. Biopsy findings were characteristic of multicore disease. However, at age 21/2 years, our patient developed congestive heart failure that was easily controlled with digitalis and diuretics. Shortly after cardiac catheterization, the patient developed a high, unexplained fever and died 26 hours later despite aggressive attempts at resuscitation. Therefore, patients with multicores in skeletal muscle may have severe weakness and may also have a predisposition to complications subsequent to anesthesia.

Cervical spine involvement in familial Mediterranean fever

We report a case of familial Mediterranean fever (FMF) complicated by nephrotic syndrome and renal failure due to amyloidosis. This case is unique in that the severity of joint involvement necessitated bilateral hip replacement and later caused cervical apophyseal joint fusion, the latter being a lesion not previously described in the course of FMF.

Evaluation of appropriateness and interpretation of serum theophylline assays

A drug utilization review of serum theophylline assays was undertaken to: (1) evaluate the prescribers' usage and interpretation of serum theophylline levels (STLs), and (2) calculate the cost of inappropriate assays. Criteria for appropriate use and interpretation were defined by an audit committee and approved by the chief medical resident. STLs were evaluated on medicine patients for a one-month period. Results of 102 levels ordered showed that 47 percent were inappropriate. The reasons cited most often for inappropriateness were: (1) previously-known STLs with no reason to expect a change in subsequent levels (26 percent); and (2) STLs drawn prior to steady state (12 percent). None of the levels evaluated had a request entered for the sampling time to be recorded. STLs were interpreted with the same degree of accuracy regardless of whether they were ordered appropriately. Results from this study suggest significant cost savings can be realized if physicians' ordering habits are corrected.

Ethotoin in seizures of childhood and adolescence

Ethotoin is an anticonvulsant that was considered minimally effective when introduced, but due to its apparent lack of side effects, there has been renewed interest in the drug for use in generalized and psychomotor seizures. We have characterized the pharmacokinetics of ethotoin in children and have found nonlinearity. Seizures were controlled in 16 of 17 patients, and there were no side effects reported. Gingival hyperplasia due to previous phenytoin therapy improved in all cases.

Thermal Stress Effects and Surface Cracking Associated With Laser Use on Human Teeth

A detailed study is reported of the potential thermal stress effects and surface cracking of human teeth after absorption of laser energy. This study was motivated by the desire to define damage thresholds if lasers are used for preventive dentistry techniques. A large group of extracted teeth was exposed to manually pulsed bursts of energy of varying durations from a CW CO2 laser. The teeth were examined photographically under magnification before and after irradiation, using fluorescent dye to facilitate observation of cracks in the tooth surface. In an attempt to understand the cracking phenomena, predictions of the temperatures and thermal stresses were made. The tooth surface in the vicinity of the focused beam impingement was assumed to behave as a semi-infinite solid for the short periods of time considered. Estimated stresses where cracking occurred are compared in the paper to measured values of the ultimate strength of tooth enamel. Results are shown to be in reasonable agreement with predictions. Based on this work, a criterion is given for minimizing surface damage to the tooth.