BACKGROUND: The pathogenesis of chronic fatigue syndrome (CFS) is unknown. Neurally mediated hypotension (NMH) has been suggested as a common comorbid condition or a potential underlying cause. METHODS: We conducted a cotwin control study of 21 monozygotic twins who were discordant for CFS. One twin met the 1994 Centers for Disease Control and Prevention criteria for CFS, and the other twin was healthy and denied chronic fatigue. The twins were selected from a volunteer twin registry in which at least 1 member reported persistent fatigue. As part of a 7-day clinical evaluation, all 21 twin pairs were evaluated with a 3-stage tilt table test with isoproterenol hydrochloride for the assessment of NMH. The presence of NMH was defined as syncope or presyncope associated with a decrease of 25 mm Hg in blood pressure and no associated increase in heart rate. RESULTS: A positive tilt table test result was observed in 4 twins with CFS (19%) and in 4 healthy twins (19%). This difference was not statistically significant (matched pair odds ratio, 1.0; 95% confidence interval, 0.2-5.4; P>.90). Compared with the healthy twins, the twins with CFS reported more severe symptoms of CFS and NMH both in the week before and during the tilt table test. CONCLUSIONS: These results do not support a major role for NMH in CFS. They highlight the importance of selecting well-matched control subjects, as well as the unique value of the monozygotic cotwin control design in the study of this illness. Arch Intern Med. 2000;160:3461-3468.

Adult↗

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Prenatal detection of fra(X)(q27.3) in female identical twins: reliability of low level cytogenetic prenatal expression in females.

UNLABELLED: Recently, we detected fra(X)(q27.3) in amniocyte cultures from female identical twins. The pregnant woman did not exhibit fra(X)(q27.3) in whole blood cultures but was the sister of 2 affected brothers. DNA marker analyses showed that she was a carrier of FRAXA. Amniotic fluid cultures (AFCs) from twins A and B exhibited the fragile X [fra(X)] chromosome, but the level of cytogenetic expression was very low in twin A's AFCs. DNA marker studies indicated both twins were carriers of FRAXA. Peripheral umbilical blood sample (PUBS) cultures exhibited fra(X)(q27.3) at a frequency of about 10% for both twins. DNA fingerprinting indicated that the twins were identical, confirming the clinical impression, with a very thin separating amniotic membrane. To our knowledge, this is the only report of prenatal fra(X)(q27.3) detection in female identical twins, and the second report of identical twin detection [Rocchi et al., 1985]. We have diagnosed prenatally fra(X)(q27.3) in 5 female fetuses using AFCs. The average fra(X) frequency was 4% for these positive female fetuses with a range of 0.5% to 8.5%. Follow-up whole blood studies confirmed our original results at an average fra(X) frequency of 25%. IN CONCLUSION: 1. Low frequencies, perhaps 1 or 2%, or a few positive cells in AFCs, are likely to increase in magnitude when confirmed in whole blood cultures either pre- or postnatally. 2. It appears likely that the risk is low for false positive results in AFCs when low frequencies of fra(X)(q27.3) are encountered.

Cytogenetics↗

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Lymphohistiocytosis: a multi-factorial syndrome of macrophagic activation clinico-pathological study of 38 cases.

Lymphohistiocytosis (LH) is defined by a widespread infiltrate of non-malignant lymphocytes and macrophages, involving principally the liver, spleen and central nervous system and associated with a severe lymphoid atrophy. For this histological study, 38 juvenile cases of LH were selected and reviewed. Morphological and histochemical studies revealed that the macrophages were activated. They appeared to be OKM1, OKT9 and HLA Dr positive and showed a patent or occult erythro and thrombocytophagocytosis. Comparatively, most of the lymphoid cells did not bear any immunoglobulin and did not label with a wide panel of monoclonal antibodies including T3, T4, T6, T8, T11. The review of the clinical and biological data of these 38 cases suggests that LH does not represent a single entity but can be regarded as a non-specific response to various causes. Three different conditions associated with LH can be isolated. The first group consists of patients in whom the disease is characterized by an early onset, high familial incidence and an inevitably fatal course. This category contains the largest number of cases (29 out of 38) and corresponds to the classic description of Familial Erythrophagocytic Reticulosis by Farquhar and Claireaux. The second group includes mainly male patients and children over 2 years old. Inheritance is not a predominant feature. The course of the disease is comparatively long. A viral infection was present in three of the seven cases. This category shares many of the clinico-pathological features of the Virus Hemophagocytic Syndrome and is presumably related to a chronic and latent viral infection. A third group can be identified on the basis of the presence of pigmentation abnormalities and immunodeficiency disorders probably associated with cytoskeletal abnormalities. This group includes Chediak-Higashi disease and Griscelli's disease. The fact that some genetic factors and immunodeficiency disorders are present in these three groups is probably significant and suggests that LH is a condition brought about by multiple factors--of which the common denominator is an apparent activation of the Mononuclear Phagocytic System.

Biopsy↗

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Severity measurement in multiple trauma by use of ICDA conditions.

We report here the results of a study of grading injury severity for patients with multiple traumatic injuries from ICDA codes listed on the face sheets of hospital medical records. We developed a method of scoring the severity of individual ICDA traumatic injuries with use of data from the NCHS Hospital Discharge Survey. When tested on a set of patients having multiple trauma conditions (also from the NCHS Hospital Discharge Survey), these scores had a strong relationship with fatality. The development of an injury severity index based on ICDA codes has considerable impact on the feasibility of conducting studies involving large numbers of patients hospitalized with traumatic injuries.

Diagnosis-Related Groups↗

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Psychosocial correlates of physical activity among fifth and eighth graders.

BACKGROUND: Identification of the factors that influence children's participation in vigorous activity is essential to the development of effective intervention strategies aimed at the prevention of cardiovascular disease and obesity. METHODS: Correlates of intent to participate in vigorous activity were assessed among 310 fifth and eighth graders in Cambridge, Massachusetts, through the development and administration of a questionnaire based on the Theory of Planned Behavior, an extension of the Theory of Reasoned Action, which includes the domain of perceived behavioral control (how easy or difficult it is to engage in vigorous activity). Heights and weights were measured and questionnaires were completed during physical education classes. RESULTS: Perceived behavioral control and attitude predicted children's intent to participate. How much a child agreed s/he was good at doing vigorous activity predicted perceived behavioral control. In each grade, girls reported being less good at vigorous activity than did boys. Eighth-grade girls reported significantly fewer hours of vigorous activity than did eighth-grade boys. CONCLUSIONS: Our findings suggest that gender differences related to intent to participate in vigorous activity, perceived behavioral control, and sense of competency are evident in eighth grade and may begin in fifth grade. These gender differences in perception therefore precede the gender difference in participation in vigorous activity demonstrated among ninth graders in the 1990 Youth Risk Behavior Survey. Promotion of activities children enjoy, and in which they feel a sense of competency, is likely to sustain participation in vigorous activity throughout adolescence and possibly reduce the prevalence of obesity.

Adolescent↗

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Evidence for genetic influences common and specific to symptoms of generalized anxiety and panic.

BACKGROUND: Generalized anxiety disorder (GAD) and panic disorder (PD) often co-occur and have been shown to be heritable. Researchers have debated the validity of the distinction between GAD and PD. To test for distinction between disorders, we estimated the genetic and environmental contributions which were specific and common to GAD and PD in a cohort of male-male twin pairs. METHODS: Data were obtained from a telephone interview performed in 1992 utilizing the Diagnostic Interview Schedule Version 3-Revised. Interviews were administered to 6724 male-male monozygotic and dizygotic twin pair members of the Vietnam Era Twin Registry. We defined lifetime GAD by the report of six or more DSM-III-R symptoms and lifetime PD by the report of four or more DSM-III-R symptoms. RESULTS: The lifetime co-occurrence of GAD and PD was best explained by a model which did not include family environmental influences. The variance in risk for GAD was due to a 37.9% influence from additive genetic factors with the remainder due to unique environmental influences. The variance in risk for PD was due to a 22.6% additive genetic contribution which was common with GAD and a 21.2% non-additive genetic contribution specific to PD with the remainder of variance in risk for PD due to unique environmental influences. LIMITATIONS: Results may be limited to middle aged males. Model fitting with full diagnostic criteria was not possible due to low prevalences. CONCLUSIONS: Our data suggest a distinction in liability for GAD versus PD. The common genetic influence to GAD and PD may partially account for the risk of the co-occurrence of these disorders in a lifetime.

Age of Onset↗

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Focal myositis of the sternocleidomastoid muscle: a case report and review of the literature.

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Female↗

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A novel, resorbable suture anchor: pullout strength from the human cadaver greater tuberosity.

The pullout strength of a collagen bone anchor that creates interference fixation as the result of radial swelling on hydration was compared with a Mitek rotator cuff anchor after insertion into the greater tuberosity of human cadaver humeri. Bones were fully hydrated at 37 degrees C. Stiffness, peak load, and the mode of failure were recorded. Real and apparent bone densities were measured. Peak load for the collagen anchor at 15 minutes (121.0N +/- 81.3N) was greater than at 2 minutes (60.5N +/- 38.5N) after insertion (P <.05). At between 5 and 60 minutes after insertion, peak loads for the Mitek and the collagen anchors did not differ. After 30 minutes from insertion, the mode of failure of the collagen anchor changed from pullout with minor body damage to pullout with major body damage. Peak load at pullout correlated with bone density for the Mitek (P <.05, r = 0.516) but for the collagen bone anchor appeared unaffected by bone density.

Aged↗

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Langerhans cell histiocytosis: retrospective evaluation of 123 patients at a single institution.

The aim of this study was to retrospectively evaluate clinical characteristics at diagnosis and outcome of patients with Langerhans cell histiocytosis (LCH). From October 1987 to March 1996, 133 patients with confirmed LCH were admitted to Hospital JP Garrahan in Buenos Aires (123 evaluable). Median age was 5 years (range 15 days to 18 years). Initial organ involvement included bone 114 patients, ear 34, skin 30, liver 18, lung 14, lymph nodes 14, spleen 12, diabetes insipidus 9, and bone marrow 2. Nineteen patients had organ dysfunction, pulmonary 14, hematological 14, and hepatic 12. Two groups were defined: Group A included patients with single system disease (uni- or multifocal) and group B multisystem (with or without organ dysfunction). In group A (n = 82), 24 patients were treated with chemotherapy (prednisone and vinblastine), 21 with surgery, 15 received radiotherapy, and 22 were only observed. Patients of group B (n = 41) were treated with chemotherapy consisting of prednisone and vinblastine, DALHX 83, or LCH1-based chemotherapy. At a median follow-up of 3 years (range 1 month-8 5/12 years) 93% of patients of group A and 39% of group B survive free of reactivation. In group B, 22% had a reactivation and 39% died of progressive disease. Sequelae were detected in 35 patients (28%), which included diabetes insipidus in 17, hearing loss in 13, bony sequelae in 11, sclerosing cholangitis in 6, and lung fibrosis with bullae in 6. Two patients had a subsequent malignant disease. A total of 17 (14%) patients died and 16 of them belonged to the group B: 13 died of progressive disease, 2 due to sclerosing cholangitis (with sepsis in one case and encephalitis in the other one), 1 with progressive disease and associated myelofibrosis, and 1 patient of group A with active disease and brain stem tumor. Patients who had organ dysfunction had a reactivation free survival of 32%. All these patients survived with sequelae. Logistic regression analysis showed that organ dysfunction and hematological involvement had significant predictive values in relation to death. Patients of group A had an excellent survival rate, whereas in those of group B a high mortality was found, especially in the subgroup of patients with organ dysfunction. Lahey's criteria should be revised. Sequelae were also more common in this group.

Adolescent↗

PubMedDate not supplied

Abnormal vasculature of solid tumours: significance for microsphere-based targeting strategies.

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Angiotensin II↗

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A five-stage model for sustaining a community campaign.

The Sisters Together, Move More Eat Better pilot communication program focuses on young Black women in three inner-city communities to encourage improved nutrition and increased physical activity. The design for Sisters Together is based on an expansion of a public health campaign that combines social marketing with community building efforts. The pilot program design comprises five phases: design, promotion, demonstration, transfer, and sustained activity. The proposed five-stage model holds potential for increasing the life span of a campaign and contributing to community building. Partnerships and coalition development promise to maintain the campaign beyond the limited budget period. This descriptive article illustrates the elements of a hybrid model for the design of a communication program with examples from Sisters Together, Move More Eat Better, a pilot program currently in the last year of implementation.

Adolescent↗

PubMedDate not supplied

Predictive value of in vitro colony and cluster formation in acute nonlymphocytic leukemia.

Granulocytic-monocytic colony-forming activity of marrow cells was evaluated at presentation in 20 patients with acute nonlymphocytic leukemia (ANLL). A double-layer agar culture was employed to determine colony- and cluster-forming activity. All patients underwent induction chemotherapy with cytosine arabinoside and daunorubicin. Five patients died during induction. Eight of the 11 patients entering complete remission had absent or decreased colony and cluster growth of marrow cells. Four patients who failed to obtain a complete remission produced increased or only cluster growth in culture. Our data support the conclusions of others that decreased colony and cluster formation in vitro is associated with a more favorable response to induction chemotherapy for ANLL.

Acute Disease↗

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Pulmonary artery stenosis resulting in ventilation-perfusion mismatch in a young female.

Pulmonary embolism is a disorder associated with significant morbidity and mortality in which early, accurate diagnosis is imperative. Controversy exists as to whether this disorder is being overdiagnosed or underdiagnosed. Processes other than pulmonary embolism may produce scintigraphic ventilation-perfusion mismatch and alter the diagnostic specificity of this technique in a small but significant subset of patients. We report a case in which pulmonary ventilation-perfusion mismatch was produced by pulmonary vessel stenosis without evidence of embolic disease. Paradoxically, although the specificity in diagnosing pulmonary embolism with scintigraphic techniques has increased markedly, still greater caution must be exercised in order to preserve this specificity.

Adult↗