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The aim of this study was to assess the skeletal metabolism in a murine model of systemic lupus erythematosus (SLE). MRL/n and MRL/l mice (respectively representing a benign and a malignant form of the disease) were observed from 1.5 to 6.5 months of life. The monthly follow-up included: biochemical and histomorphometrical studies of the femoral bone, serum biochemistry, immunoglobulins and osteocalcin, and histological evaluation of the kidney tissue. The results showed a higher femoral weight (+11.5%), calcium (+4.4%) and protein bone content (+11.4%) and a significantly higher (+77%) phosphorus bone content in the MRL/n group; significantly lower (-48.9%) bone alkaline phosphatase enzymatic activity, lower bone alkaline/acid phosphatase enzymatic activities ratio (-40.8%) and lower (-38.4%) serum osteocalcin values in the MRL/l group (which might suggest reduced bone formation in these animals); markedly smaller trabecular bone volume (BV/TV) in the femoral head (-36.2%) and femoral neck (-39.8%), and smaller cortical and femoral areas in the mid-femoral shaft (-38.8% and -38.1% respectively) in the MRL/l group; higher serum immunoglobulins, increased serum blood urea nitrogen (BUN) and creatinine and a higher index of activity in the kidney histology in the MRL/l group, indicating increased activity of the disease in this substrain. The MRL mice, through their two substrains, may serve as a valuable laboratory animal model for study of the skeletal changes in SLE and of the influence of the disease activity on the skeletal metabolism. [ABSTRACT FROM AUTHOR]

Study Objective: --To determine if body fat distribution affected endometrial cancer risk.Design: --Case-control study.Setting: --This study was carried out at the H. Lee Moffitt Cancer Center at the University of South Florida, Tampa, where all patients in the case group received their diagnoses and histological confirmations.Patients: --Forty consecutive women newly diagnosed with endometrial cancer and 40 controls matched for age and Quetelet index.Main Outcome Measures: --Anthropometric measurements were taken for the abdomen, thigh, suprailiac, subscapular, biceps, and triceps skin fold thicknesses; waist and hip circumferences, weight, and height. Relative risks for endometrial cancer were calculated according to these anthropometric measurements.Results: --Case patients with endometrial cancer had significantly greater waist-to-hip circumference ratios (P less than .001), abdomen-to-thigh skin fold ratios (P less than .01), and suprailiac-to-thigh skin fold ratios (P = .02) compared with control subjects matched for age and Quetelet index. The relative risk for endometrial cancer increased with an increasing waist-to-hip circumference ratio (less than or equal to 1.14 = 1.0; greater than 1.14 = 15.0), with an increasing abdomen-to-thigh skin fold ratio (less than or equal to 0.82 = 1.0; greater than 0.82 = 5.0), and with an increasing suprailiac to-thigh skin fold thickness ratio (less than or equal to 0.67 = 1.0; greater than 0.67 = 3.50).Conclusion: --Upper-body fat localization is a significant risk factor for endometrial cancer in women matched for age and Quetelet index. [ABSTRACT FROM AUTHOR]

A patient with systemic lupus erythematosus (SLE) developed primary subcutaneous nocardiosis during steroid and cyclophosphamide therapy for diffuse proliferative glomerulonephritis. In spite of local process the patient manifested signs of general deterioration mimicking SLE exacerbation. The diagnosis was made by bacteriologic examination of the material obtained by CT guided aspiration. Surgical drainage and systemic treatment with trimetoprim/sulphamethoxazole (TMT/SMZ) 960 mg twice/d led to a clinical recovery and enabled the continuation of the steroid and cytotoxic regimen. [ABSTRACT FROM AUTHOR]

A clinic supervised by a nurse, using principles originally developed in general practice, was established in the paediatric department of a district general hospital. A randomised controlled study was conducted comparing children admitted with asthma or attending outpatients who were given a patient education programme and self management plan (intervention group) with a control group. The study comprised 91 patients aged 3-14 years admitted for asthma or attending a hospital outpatient department from November 1989 to November 1990. Seventy seven patients completed the study and kept diaries for a median of 283 days. Patients in the intervention group had significantly less restriction of activity (95% confidence interval (CI) -0.27 to -0.01) and fewer episodes of peak flow below 30% of best (95% CI 0.03 to 1.17). Patients in the intervention group were more likely to make the correct response to an acute exacerbation of their asthma than the control group (71% v 47%, 95% CI 9.51 to 39.1). The intervention group had fewer school absences and fewer home visits by a general practitioner. There was an increase in the readmission rate for the intervention group. A subgroup of patients who self managed by doubling their use of inhaled steroids during an exacerbation performed better than those patients who only increased their bronchodilator or were managed on salbutamol or sodium cromoglycate alone. Improvements in patient follow up and the structure of the self management plans used, particularly changing the peak flow level at which inhaled steroids are doubled, may further improve the outcome of patients attending the asthma clinic. [ABSTRACT FROM AUTHOR]

Coined in French in the early 1820s as a mere description of a pathological state of the bone, the term 'osteoporosis' made its way into the English medical vocabulary only in the twentieth century. Unlike other medical concepts, which have not been substantially altered by progress in medical research, the definition of osteoporosis has constantly reflected the state of knowledge on the phenomenon itself. Over its 170 years of evolution, this definition has continuously sought to maintain a difficult balance between physiological and clinical criteria. Even at present, while the 1990 Consensus Conference definition (centering mainly on physiological deterioration) merely implies the clinical aspect through the notions of fragility and fracture risk, others advocate restriction of the term to the clinical consequences of osteopenia. How will the concept of osteoporosis develop in the future? This article, which deals with the origin of the term and its successive definitions, is offered as a basis for further discussion on this subject of high topicality. [ABSTRACT FROM AUTHOR]

Severe myalgia is an uncommon feature of familial Mediterranean fever (FMF). A patient is presented in whom acute myalgia and high fever were the sole clinical findings during an FMF attack. The ultrastructural picture of the muscle tissue during the acute stage was characterised by a large deposition of collagen fibrils. The myalgia subsided during colchicine treatment. The clinical and ultrastructural features of myalgia in FMF are discussed in the light of the relevant literature. [ABSTRACT FROM PUBLISHER]

Study Objective: To determine if body fat distribution affects breast cancer risk.Design: Prospective case-control study.Patients: The anthropometric measurements of 216 consecutively and newly diagnosed women with invasive carcinoma of the breast were compared with those of 432 age-matched controls. The anthropometric measurements taken were abdomen, thigh, suprailiac, biceps, triceps, subscapular, and midaxillary skinfolds; waist and hip circumference; and weight and height. Women between 25 and 83 years of age were included in the study.Results: Patients with breast cancer had a significantly greater waist:hip circumference ratio than controls (P less than 0.001) and a significantly greater suprailiac:thigh skinfold ratio (P less than 0.001). The relative risk for breast cancer increased with increasing waist:hip circumference ratio (less than 0.73 = 1.00; 0.73 to 76 = 1.90; 0.77 to 0.80 = 2.83; greater than 0.80 = 6.46) and with suprailiac:thigh skinfold ratio (less than 0.42 = 1.00; 0.42 to 0.56 = 1.85; 0.57 to 0.71 = 2.25; greater than 0.71 = 5.85). At other sites of upper body obesity, such as the biceps and triceps, skinfolds were significantly greater in patients with breast cancer.Conclusion: Although obese women are at slightly higher risk for developing breast cancer, women with android obesity are a segment of obese women who appear to be at a significantly higher risk for developing breast cancer. [ABSTRACT FROM AUTHOR]

Objective: To describe the immune response of preterm infants, with a reduced response to primary Hoemophilus influenzae type B (Hib) immunisation, to a Fourth dose of Hib conjugate vaccine given in early life. Design: Prospective observational study. Setting: Five Wessex Neonatal Units. Patients: Infants born at < 32 weeks and immunised with three doses of combined acellular pertussis-Hib vaccine, with a Hib IgG geometric mean concentration (GMC) < 1.0 μg/ml after, these primary immunisations. Interventions: An additional fourth dose of Hib conjugate vaccine given before 1 year of age. Blood taken to assess Hib IgG concentration and avidity alter immunisation. Main outcome measures: Hib IgG GMC and avidity index. Results: Ninety six infants (mean gestational age at birth 29.1 weeks) received a fourth dose of Hib at a mean age of 7.8 months. Hib IgG GMC after the primary immunisations was 0.17 μg/ml (95% confidence interval (Cl) 0.14 to 0.20) rising to 4.68 μg/ml (95% Cl 3.36 to 6.57) after the fourth dose (p < 0.0001). The IgG response to the fourth dose correlated positively with the response after the primary immunisations (p < 0.001). Hib IgG geometric mean avidity index (GMAI) after the primary immunisations was 30.87 (95% Cl 20.40 to 46.73). This increased to 124.73 (95% Cl 109.93 to 141.51) after the fourth dose (p < 0.0001). Conclusion: Preterm infants with very low IgG responses to Hib after primary immunisations with a combined acellular pertussis-Hib vaccine mount a good response to a fourth dose of Hib. This study suggests that all infants wilt benefit from a fourth dose of Hib, regardless of the age at which it is given. [ABSTRACT FROM AUTHOR]

A twelve year old boy presented with acute cervical and interscapular pain, torticollis and low grade fever. The neurological examination was normal. Roentgenograms showed calcification of the T3-T4 disc and posterior herniation of the nucleus pulposus was demonstrated by computed tomography. A rapid and dramatic amelioration of the symptoms was produced by treatment with a non-steroidal anti-inflammatory drug. Intervertebral disc calcification in childhood is an uncommon and usually benign condition. Its clinical and radiological features are discussed in the light of the relevant literature. [ABSTRACT FROM AUTHOR]