Silicate antibodies in Danish women with silicone breast implants

OBJECTIVES

To use a new immunological assay to evaluate silicate antibody levels in women with and without silicone breast implants (SBIs).

METHODS

Women (n=186) were identified through Danish population-based registers and categorized into six groups defined by prior breast surgery (breast implantation/breast reduction/no breast surgery) and by the presence or absence of prior hospital diagnoses of soft-tissue rheumatism (muscular rheumatism, ICD-8 codes 717.90 and 717.99). The women underwent blood tests, a silicate antibody assay and a clinical examination. Severity of rheumatic symptoms/signs was scored from 1 (none) to 5 (severe).

RESULTS

The level of silicate antibodies was not significantly different between the three groups with prior soft-tissue rheumatism (P > 0.5), with the lowest value among women with SBIs. Among women who had no prior diagnosis of soft-tissue rheumatism, silicate antibody levels were highest in women with SBIs (P < 0.01). No significant correlations were observed between silicate antibody levels and symptom severity scores.

CONCLUSIONS

Silicate antibodies were not consistently associated with SBIs and were not correlated with rheumatic symptoms. The clinical relevance of these antibodies remains questionable.

Bone mineral density in fibromyalgia patients--correlation to disease activity

OBJECTIVE

To compare bone mass (BMD) in women with fibromyalgia (FM) with healthy females, and to evaluate whether self-reported pain and lack of functional capacity correlate to reduced BMD in FM patients.

METHODS

Thirty-one FM patients (20 pre- and 11 postmenopausal) and fourty-one healthy women (30 pre- and 10 postmenopausal) were enrolled in the study. BMD of the lumbar spine and the femoral neck was measured by a DEXA (Norland) scanner. Self reported pain was measured on a Visual Analog Scale (VAS). The Activity of Daily Living (ADL) component of the Fibromyalgia Impact Questionnaire (FIQ-ADL) was used as measure for physical capacity.

RESULTS

BMD-lumbar spine and BMD-femoral neck did not differ significantly between FM patients and controls, though premenopausal FM patients tended to have lower BMD-femoral neck (p = 0.09). Self reported pain and FIQ-ADL among FM patients correlated with BMD-femoral neck (r(s) = -0.52, p = 0.003); (r(s) = -0.31, p = 0.09).

CONCLUSION

Premenopausal FM patients tended to have lower BMD of hip than controls. Self reported pain correlated negatively to BMD. Thus, the severity of FM might have a negative impact on bone mass.

Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia

Dental treatment in children who are too young or too apprehensive to cooperate is often performed under sedation. In Sweden, the tradition has been to administer sedatives rectally in small children, but oral liquid sedation is now increasingly used.

AIM

To compare the sedative effects of oral and rectal administration of midazolam in children undergoing dental treatment under general anaesthesia and to assess acceptance of sedative administration, acceptance of application of the facemask, and amnesia.

METHODS

Fifty children aged 2-7 y were randomly allocated to receive either liquid oral or rectal sedation, with 25 children in each group.

RESULTS

The sedative effect of rectal administration was higher, but not statistically significantly, than that of oral administration (p = 0.07). No significant differences in acceptance of sedative administration, acceptance of mask application or amnesia were found between the groups.

CONCLUSION

Both the oral and the rectal routes can in most cases be appropriate. However, the better sedative effect of rectal administration of midazolam makes it a more favourable route in pre-cooperative and non-compliant children.

Rheumatic manifestations in danish women with silicone breast implants

The aim of this study was to investigate whether women with silicone breast implants (SBI) present with a unique rheumatic symptomatology. We assessed the profile of rheumatic disease in six groups of women identified through Danish hospital and population registers, three groups of women with a prior hospital diagnosis of muscular rheumatism (a non-specific diagnostic code) who had previously undergone SBI surgery (n = 28), breast reduction surgery (n = 29) or no breast surgery (n = 27); and three groups of women without a diagnosis of muscular rheumatism who had undergone SBI surgery (n = 21), breast reduction surgery (n = 27) or no breast sugery (n = 56). All women in the study population (n = 188) underwent a thorough clinical examination, blood tests and a personal interview. In all study groups soft-tissue rheumatism and degenerative diseases were the most frequent diagnoses. Women with a prior diagnosis of muscular rheumatism but no prior breast surgery had a significantly higher prevalence of soft-tissue rheumatism than those with breast implant or reduction surgery. No significant differences in the frequencies of rheumatic diseases were observed among the three groups of women without previous muscular rheumatism. No specific pattern of inflammatory rheumatic disorders or soft-tissue complaints was identified among the women with SBI, and blood tests for autoimmunity revealed no unique pattern. Overall, women with earlier rheumatism had significantly increased frequencies of rheumatic conditions than did those without. We found no evidence of a rheumatic symptomatology unique to women with silicone breast implants. Our study emphasises the need for consideration of prior rheumatic disease when evaluating rheumatic manifestations in women with SBI.

Comparison of sport achievement orientation between wheelchair and able-bodied basketball athletes

Differences in sport achievement orientations between 31 recreational wheelchair and 76 able-bodied basketball athletes were tested. Athletes from the New England region completed the three subscales of the Sport Orientation Questionnaire (competitiveness, win orientation, and goal orientation). Wheelchair athletes responded higher on the Competitiveness and Goal Orientation subscales. In discriminative function analysis competitiveness scores were the only significant discriminator between the two groups.

Self-reported symptoms among Danish women following cosmetic breast implant surgery

The aim of this study was to examine self-reported symptomatology and to identify distinctive characteristics among women with silicone breast implants (SBI). Using the Danish hospital and population registers we identified three groups of women with a hospital diagnosis of muscular rheumatism (a nonspecific soft-tissue diagnostic code) who had previously undergone SBI surgery (n = 28), breast reduction surgery (n = 29) or no breast surgery (n = 27); and three groups of women without a diagnosis of muscular rheumatism who had undergone SBI surgery (n = 21), breast reduction surgery (n = 27) or no breast surgery (n = 56). All study subjects completed a self-administered questionnaire focusing on sociodemographic factors, lifestyle habits, somatic symptoms and psychological symptoms. Women with SBI and women with breast reduction with no previous diagnosis of muscular rheumatism had similar patterns of reporting for most symptoms and characteristics. They reported significantly more somatic symptoms and psychological distress, including somatisation, obsessive-compulsiveness and depression, than women with no breast surgery. No significant differences in self-reported symptomatology and characteristics were observed among the three groups of women with a previous diagnosis of muscular rheumatism. Overall, women with prior muscular rheumatism reported more symptoms than those without. We concluded that self-reported somatic symptoms among women with SBI were similar to those of controls. Women with cosmetic breast surgery appear to have distinctive psychological characteristics. Our study emphasises the importance of taking the psychological profile and previous history of rheumatic diseases into account when examining women with SBI.

Nitrogen deposition to and cycling in a deciduous forest

The project described here seeks to answer questions regarding the role increased nitrogen (N) deposition is playing in enhanced carbon (C) sequestration in temperate mid-latitude forests, using detailed measurements from an AmeriFlux tower in southern Indiana (Morgan-Monroe State Forest, or MMSF). The measurements indicate an average atmosphere-surface N flux of approximately 6 mg-N m(-2) day(-1) during the 2000 growing season, with approximately 40% coming from dry deposition of ammonia (NH3), nitric acid (HNO3), and particle-bound N. Wet deposition and throughfall measurements indicate significant canopy uptake of N (particularly NH4+) at the site, leading to a net canopy exchange (NCE) of -6 kg-N ha(-1) for the growing season. These data are used in combination with data on the aboveground C:N ratio, litterfall flux, and soil net N mineralization rates to indicate the level of potential perturbation of C sequestration at this site.

Long-term seropositivity against Echinococcus multilocularis in an epidemiological follow-up study in southwestern Germany (Römerstein)

BACKGROUND

Out of 2,560 participants in an epidemiological survey of alveolar echinococcosis (AE) performed in 1996 in southwestern Germany, 47 participants had tested seropositive in one of two crude antigen screening ELISAs and were inconspicuous on hepatic ultrasound.

PATIENTS AND METHODS

Out of these 47 seroreactors, 36 attended a follow-up examination 30 months after the primary examination, including ultrasound and serology with various Echinococcus multilocularis-specific antigens.

RESULTS

No lesion suspicious for AE was detected in any participant. Serology showed only minor changes as compared to the earlier results.

CONCLUSION

Persistent seropositivity without detectable hepatic lesions could be interpreted as an early sign of sonographically not yet detectable AE, immunity to E. multilocularis or unspecific serological reactivity. For seropositive and clinically inconspicuous inhabitants of areas endemic for AE follow-up examinations at intervals of 2-3 years seem to be adequate.

Identification of a novel class of insect glutathione S-transferases involved in resistance to DDT in the malaria vector Anopheles gambiae

The sequence and cytological location of five Anopheles gambiae glutathione S-transferase (GST) genes are described. Three of these genes, aggst1-8, aggst1-9 and aggst1-10, belong to the insect class I family and are located on chromosome 2R, in close proximity to previously described members of this gene family. The remaining two genes, aggst3-1 and aggst3-2, have a low sequence similarity to either of the two previously recognized classes of insect GSTs and this prompted a re-evaluation of the classification of insect GST enzymes. We provide evidence for seven possible classes of insect protein with GST-like subunits. Four of these contain sequences with significant similarities to mammalian GSTs. The largest novel insect GST class, class III, contains functional GST enzymes including two of the A. gambiae GSTs described in this report and GSTs from Drosophila melanogaster, Musca domestica, Manduca sexta and Plutella xylostella. The genes encoding the class III GST of A. gambiae map to a region of the genome on chromosome 3R that contains a major DDT [1,1,1-trichloro-2,2-bis-(p-chlorophenyl)ethane] resistance gene, suggesting that this gene family is involved in GST-based resistance in this important malaria vector. In further support of their role in resistance, we show that the mRNA levels of aggst3-2 are approx. 5-fold higher in a DDT resistant strain than in the susceptible strain and demonstrate that recombinant AgGST3-2 has very high DDT dehydrochlorinase activity.

Benzodiazepines in child dental care: a survey of its use among general practitioners and paediatric dentists in Sweden

Dental treatment in children too young or too apprehensive to co-operate is often performed under sedation. The aim of this study was to survey the use of rectal and oral liquid and tablet benzodiazepine sedation in Swedish child dentistry, and estimation of treatment success. A questionnaire was sent to 500 randomly selected dentists (GPs) working in the Public Dental Health Service and all (77) specialists (PDs) working at paediatric dentistry clinics. Benzodiazepine sedation was used by 73% of the GPs and 97% of the PDs. Seven per cent of the GPs and 87% of the PDs had sedation sessions at least once a month. Of the GPs, 60% administered the sedation rectally, 7% orally in liquid form, and 39% orally in tablet form. For PDs, the corresponding figures were 97%, 78%, and 68%. Sixteen per cent of the GPs and 84% of the PDs used midazolam for rectal sedation. PDs rated rectal sedation better than the GPs (p < 0.001). GPs rated their experiences of rectal sedation as better the more frequent the use (p = 0.03), as did PDs concerning oral liquid sedation (p = 0.03). Thus, it seems that a more regular use of sedation is advantageous in achieving better treatment outcome.

[A controlled trial of training in knee arthritis]

INTRODUCTION

The aim was to investigate the effectiveness and safety of a physical training programme in patients with severe osteoarthritis of the knees.

MATERIAL AND METHODS

Twenty-five patients participated in this randomised clinical trial with a blind observer. Intervention consisted in training twice a week for three months and focused on general fitness, balance, co-ordination, and muscle strength. Follow-up was performed at 3 and 12 months. The recorded parameters were muscle strength, algofunctional index, pain, walking speed, and clinical findings.

RESULTS

At three months follow-up, muscle strength had improved in the intervention group. By one year, pain at night had decreased, but the number of palpable knee joint effusions had increased.

CONCLUSION

A general physical training programme appears to be beneficial to patients with osteoarthritis of the knees, but further investigation of the safety of such a programme is called for.

[Lateral humeral epicondylitis--"tennis elbow". I. Epidemiology, clinical picture and pathophysiology]

Lateral epicondylitis (LE) is a common overuse syndrome of unknown etiology. Studies imply that it is mostly a degenerative condition implying that the term "epicondylitis" is a misnomer. LE often occurs in middle-aged persons in connection with acute or chronic strain. Symptoms are mostly related to occupational tasks. Other conditions can cause pain in the lateral elbow region, and it is important to know the differential diagnosis in order to start the proper treatment. The diagnosis is mainly based on clinical findings but may be substantiated by other diagnostic techniques, such as magnetic resonance imaging. However, the specificity and the sensitivity of these techniques are unclarified.

[Lateral humeral epicondylitis--"tennis elbow"]

There is a great variety of potential therapies in the treatment of lateral epicondylitis, surgical intervention being the most invasive. The most frequently applied therapies are corticosteroid injections, pain-relieving medication (NSAID) and physical therapy. Though many studies have been conducted, a "gold standard" in the treatment of LE is not available. Perhaps this is explained by a lack of methodological quality of many of these studies.

[Comparison of two different treatments of lateral humeral epicondylitis--"tennis elbow". A randomized controlled trial]

INTRODUCTION

Many therapeutic interventions have been used in the treatment of lateral epicondylitis (LE), but to date, no specific intervention has proved universally efficacious. The aim of this study was to compare local corticosteroid injections versus splinting in a randomized controlled design.

MATERIAL AND METHODS

Sixteen patients were treated with injections, and fourteen with a wrist splint. The patients were evaluated at inclusion and after six weeks with grip strength and pain scores. The patient's global assessment was used as a main indicator of improvement.

RESULTS

No differences were noticed between the two groups. Most patients improved. A questionnaire after > 1 year showed that some patients still had pain complaints.

DISCUSSION

We conclude that injections were as effective as splinting in LE. Splinting is recommended in the early stages of the disorder because of its lack of adverse effects. In the long view diagnostics regarding LE have to be refined in order to differentiate patients who are expected to benefit from different treatments.

Comparison of viral antibodies in 2 groups of patients with fibromyalgia

OBJECTIVE

The etiologies of fibromyalgia (FM) are unknown. In some cases an acute onset following a flu-like episode is described; in other cases patients report slowly developing disease. We previously found increased prevalence of enterovirus IgM antibodies in patients with acute onset of FM compared to healthy controls. We looked for differences in antimicrobial IgM antibodies in acute versus nonacute onset FM.

METHODS

Two well defined, comparable groups of patients with FM (acute 19, nonacute 20) were studied for antibodies in serum to an array of viruses including IgM antibodies.

RESULTS

In most viruses no IgM antibodies were found. However, about 50% of the patients with acute FM onset had IgM antibodies against enterovirus compared to only 15% of the slow onset patients.

CONCLUSION

The higher prevalence of IgM antibodies against enterovirus in patients with acute onset of FM may indicate a difference in the etiology or the immune response in these patients.

Search for Borna disease virus in Danish fibromyalgia patients

OBJECTIVE

The purpose of this study was to look for Borna disease virus (BDV) in 18 patients with acute onset of fibromyalgia (FMS) following a "flu-like" episode. BDV is a neurotropic RNA virus affecting horses and sheep. Infections in animals have been reported to cause immune mediated disease characterized by abnormalities in behavior. A possible link between BDV and neuropsychiatric diseases in man has been described, and lately a connection to chronic fatigue syndrome (CFS) has been suggested.

METHODS

A BDV-specific nested PCR (RT-PCR) was performed on serum and spinal fluid.

RESULTS

The BDV genome was not detected in any of the FMS cases.

CONCLUSION

Although BDV was not demonstrated in spinal fluid or serum from the tested patients with FMS, we believe that it is important to report our results, since FMS can exhibit many manifestations in common with CFS. Possible reasons for the discrepant findings are discussed.

Genetic mapping of two loci affecting DDT resistance in the malaria vector Anopheles gambiae

Resistance to the insecticide DDT in the mosquito vectors of malaria has severely hampered efforts to control this disease and has contributed to the increase in prevalence of malaria cases seen in recent years. Over 90% of the 300-500 million annual cases of malaria occur in Africa, where the major vector is Anopheles gambiae. DDT resistance in the ZAN/U strain of An. gambiae is associated with an increased metabolism of the insecticide, catalysed by members of the glutathione S-transferase (GST) enzyme family, but the molecular mechanism underlying this metabolic resistance is not known. Genetic crosses show that resistance is autosomal and semidominant. We have used microsatellite markers to identify two quantitative trait loci (QTL), which together explain over 50% of the variance in susceptibility to DDT in the ZAN/U strain of An. gambiae. The first locus, rtd1, is on chromosome 3 between markers H341 and H88 and has a recessive effect with respect to susceptibility. The second locus, rtd2 is on chromosome 2L, close to marker H325 and has an additive genetic effect. The markers flanking these two QTL have been physically mapped to An. gambiae polytene chromosomes. They do not coincide with any of the GST genes that have been cloned and mapped in this species. Characterization of these QTL will lead to a clearer understanding of the mechanisms of metabolic resistance to DDT.

Identification of a point mutation in the voltage-gated sodium channel gene of Kenyan Anopheles gambiae associated with resistance to DDT and pyrethroids

A field trial of permethrin-impregnated bednets and curtains was initiated in Western Kenya in 1990, and a strain of Anopheles gambiae showing reduced susceptibility to permethrin was colonized from this site in 1992. A leucine-phenylalanine substitution at position 1014 of the voltage-gated sodium channel is associated with resistance to permethrin and DDT in many insect species, including Anopheles gambiae from West Africa. We cloned and sequenced a partial sodium channel cDNA from the Kenyan permethrin-resistant strain and we identified an alternative substitution (leucine to serine) at the same position, which is linked to the inheritance of permethrin resistance in the F(2) progeny of genetic crosses between susceptible and resistant individuals. The diagnostic polymerase chain reaction (PCR) developed by Martinez-Torres et al. [(1998) Insect Mol Biol 7: 179-184] to detect kdr alleles in field populations of An. gambiae will not detect the Kenyan allele and hence reliance on this assay may lead to an underestimate of the prevalence of pyrethroid resistance in this species. We adapted the diagnostic PCR to detect the leucine-serine mutation and with this diagnostic we were able to demonstrate that this kdr allele was present in individuals collected from the Kenyan trial site in 1986, prior to the introduction of pyrethroid-impregnated bednets. The An. gambiae sodium channel was physically mapped to chromosome 2L, division 20C. This position corresponds to the location of a major quantitative trait locus determining resistance to permethrin in the Kenyan strain of An. gambiae.

Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature

Mebendazole and albendazole are the drugs of choice for the treatment of alveolar echinococcosis. In this open-labelled observational study we present and evaluate the outcome of long-term treatment with these drugs and present results of different treatment regimens. Thirty-five patients were started on either mebendazole or albendazole at the beginning of 1992 and followed for an average of 39 months (range 12-79 months). Treatment was classed as successful if the disease had not progressed for >1 year and if there were no side-effects necessitating a change of treatment. Lack of progression was evaluated mainly using ultrasound and computed tomography and was further substantiated by laboratory tests and clinical findings. The overall success rate was 97%. An initial regimen for cases of alveolar echinococcosis was recurrence-free in 71% of those treated with mebendazole and in 78% of those treated with albendazole. Four out of five cases with progressive disease stabilized after the therapeutic regimen was changed. Seven patients received a continuous regimen with albendazole. These patients were observed over an average of 28 months (range 13-50 months) without signs of progression or significant side-effects. This open-labelled prospective study demonstrates the high therapeutic efficacy of both mebendazole and albendazole with similar response rates in the treatment of alveolar echinococcosis. Albendazole reduced costs by >40% and is easier for patients to take, further arguing in favour of its preferred use. Albendazole in alveolar echinococcosis is only licensed for intermittent application. None the less, continuous treatment is safe and well tolerated and showed promising results when applied to patients in whom other treatment regimens had failed. It should thus be strongly considered in inoperable cases or progressive disease.