Interferential therapy: lack of effect upon experimentally induced delayed onset muscle soreness.

This study was designed to assess the analgesic effects of interferential therapy (IFT) on experimentally induced muscular pain under randomized, double-blind, placebo-controlled conditions. After ethical approval and written consent were obtained, 40 healthy human volunteers (20 males: 20 females) aged 18-25 years were recruited and randomly assigned to one of four experimental groups (n = 10 per group: male = female): IFT 1, IFT 2, control or placebo. Delayed onset muscle soreness (DOMS) was induced in the elbow flexors of the non-dominant arm of each subject using a single bout of eccentric exercises to exhaustion. Measurements of isometric peak torque, resting angle, mechanical pain threshold and visual analogue scales were performed at set time points. Treatment was applied for 30 min daily over the biceps brachii muscle, for five consecutive days, according to group allocation. IFT 1 received 10-20 Hz, whilst subjects in IFT 2 were treated with 80-100 Hz (bi-pole; carrier frequency: 4 kHz; pulse duration: 125 microseconds). For the placebo group, the procedure was identical to that in the active treatment groups; however, no interferential current was delivered. The control group received no treatment. No significant between group difference was identified at any time point (P > or = 0.14). However, some inconsistent, yet significant differences in daily treatment effects, interactive effects and effects over time were detected. Based on the results of this study it can be concluded that application of IFT at the parameters used here, had no overall beneficial effect on DOMS.

Low intensity monochromatic infrared therapy: a preliminary study of the effects of a novel treatment unit upon experimental muscle soreness.

BACKGROUND AND OBJECTIVE: The current study (for which ethical approval was obtained) sought to assess the effect of low intensity monochromatic infrared therapy (LIMIRT) on experimentally induced delayed onset muscle soreness (DOMS). STUDY DESIGN/MATERIALS AND METHODS: Healthy volunteers were recruited (n = 24, 12M:12F) and randomly allocated under strict double blind conditions to one of three experimental groups (n = 8, 4M:4F): Control, Placebo, or Treatment (840 nm; 3.0 J cm(-2), pulse frequency 1 kHz). DOMS was induced in a standardised manner in the biceps brachii of the nondominant arm. Subjects attended on 5 consecutive days during which the degree of pain and functional impairment was assessed. RESULTS: Analysis of results by using nonparametric Freidman and Kruskal-Wallis H tests (with relevant post hoc tests) revealed significant differences (P < 0.05) between Control and LIMIRT treatment groups for pain and tenderness scores. Despite trends in favour of the Treatment group, analysis failed to show any significant differences between the LIMIRT treatment and Placebo groups for all variables except mechanical pain threshold points 3-6 on day 2. CONCLUSION: The results of the current study suggest that LIMIRT is ineffective in the management of DOMS at the parameters investigated.

Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors.

BACKGROUND: Recent epidemiologic studies in Europe using antigliadin (AGA) and anti-endomysium antibodies (AEA) for initial screening have shown that the overall prevalence of celiac disease (CD) is about 1:300. There are no comparable scientific data for the USA, where CD is considered rare. The main aim of this study was to determine the prevalence of increased AEA in healthy blood donors in the USA. METHODS: Sera from 2000 healthy blood donors were screened for IgG AGA and IgA AGA with an enzyme-linked immunosorbent assay test. All those with increased AGA levels, those with intermediate levels, and random samples with low levels were tested for AEA, using both monkey esophagus (ME) and human umbilical cord (HUC) cryosections as substrates. RESULTS: The mean age of the blood donors was 39 years, with 52% being men, 85.2% being Caucasian, 11.8% African-American, 1.5% Asian, and 1.5% Hispanic. Eight healthy blood donors had positive AEA tests on both monkey esophagus and human umbilical cord. Among the eight subjects with increased AEA levels seven were Caucasian and one was African-American. All the four examined AEA-positive donors carried the known susceptibility alleles for CD. CONCLUSIONS: The prevalence of increased AEA levels in healthy blood donors in the USA is 1:250 (8:2000). This is similar to that reported in countries in Europe, where subsequent small-intestinal biopsies have confirmed CD in all those with AEA positivity. On the basis of a high positive predictive value of the AEA antibody test, it is likely that the eight blood donors identified in this study have CD. These data suggest that CD is not rare in the USA and that there is need for a large-scale epidemiologic study to determine the precise prevalence of the disease in the USA.

An epidemiology study of lung function changes of toluene diisocyanate foam workers in the United Kingdom.

OBJECTIVE: To determine whether longitudinal declines in ventilatory capacity and the occurrence of respiratory symptoms in workers manufacturing polyurethane foam were related to toluene diisocyanate (TDI) exposure. METHODS: A population of 780 workers in 12 United Kingdom factories was followed for 5 years. Modified United Kingdom Medical Research Council (MRC) respiratory questionnaires and three or more lung function measurements were completed for each subject. Mean TDI exposures for all jobs in which subjects were employed were assessed by personal monitoring (2294 measurements) and related to their occupational histories. RESULTS: The United Kingdom 8-h and 15-min maximum exposure limits for TDI were exceeded in 4.7% and 19.0% of the samples taken, respectively. There was some increase in reported respiratory symptoms amongst exposed workers, but the annual declines of 1-s forced expiratory volume (FEV1) and forced vital capacity (FVC) were not related to TDI exposure and were typical of those observed in other longitudinal populations. FEV1 declines were smoking-related. Evidence was found suggesting that a small excess decline in FEV1 and FVC occurred in the first few years of employment for workers not previously exposed to TDI. CONCLUSION: This study does not provide evidence that there is a TDI-related decline in FEV1 and FVC in workers exposed to less than the United Kingdom 8-h occupational exposure limit of 5.8 ppb.

Epidermal growth factor up-regulates sodium-glucose cotransport in enterocyte models in the presence of cholera toxin.

BACKGROUND: Sodium-glucose cotransport by enterocytes is key to the successful implementation of oral rehydration in diarrhea. Confluent, differentiated Caco-2 cells have enterocyte-like characteristics. We have previously shown that short-term incubation of isolated rat jejunal enterocytes with epidermal growth factor (EGF) results in the up-regulation of sodium-glucose cotransport. The aim of this study was to examine the effect of EGF on Caco-2 cells in the presence of cholera toxin. METHODS: Caco-2 cells grown on tissue culture dishes were used for glucose and sodium uptake studies and cells were grown on polycarbonate membranes for transport examinations. Effects of EGF on the kinetic parameters of sodium-glucose contransporter, thymidine transport, and on the activity of Na+/K(+)-ATPase were examined. The efficacy of basolateral vs apical EGF on sodium and glucose transport was compared after incubation of the monolayers with 10 nmol/L of cholera toxin. RESULTS: EGF increased both glucose and sodium uptake and transport, and we observed a simultaneous increase in the activity of Na+/K(+)-adenosine triphosphatase (ATPase). Kinetic studies performed on brush-border membrane vesicles prepared from EGF-incubated confluent monolayers and on intact cells showed an increase in the maximum velocity but not the Michaelis constant, suggesting increased availability of transporters rather than conformational change. This effect was seen within minutes in both of the two putative transporters, high-affinity, low-capacity and low-affinity, high-capacity. There was no acute effect on thymidine uptake. Studies in the presence of cholera toxin demonstrated a significant up-regulation in sodium-glucose cotransport when EGF was applied from the basolateral side; the increase was smaller but significant with apical application. CONCLUSIONS: Differentiated Caco-2 cells have two kinetically distinct sodium-glucose cotransporters. Short-term incubation of Caco-2 cells with EGF resulted in an up-regulation of sodium-glucose cotransport and subsequent increase in Na+/K(+)-ATPase activity. The effect of basolaterally applied EGF was more significant with or without incubation with cholera toxin. The early effect of EGF on glucose and sodium cotransport may have important therapeutic implications in diarrhea and dehydration states. The in vitro model described here uses a homogeneous cell population and provides a versatile system for uptake and transport studies.

Isocaloric glutamine-free diet and the morphology and function of rat small intestine.

BACKGROUND: The importance of L-glutamine as metabolic fuel for enterocytes and its role in prevention of mucosal atrophy during total parenteral nutrition is well documented. No data are available to date that document whether a glutamine-free complete enteral diet, requiring full energy expenditure for hydrolysis and absorption, is associated with changes in the morphology and function of the small intestine. Our aim was to examine the effect of such a diet during a 4-week period on the morphology and function of the small intestine of rats. METHODS: Three isocaloric solid rat food, containing 0%, 4%, and 8% of glutamate, respectively, were fed to three groups of rats. On the 7th and 28th days the morphology of the jejunum, the subcellular structure of enterocytes on transmission electron microscopy, enzyme activities, blood, and muscle glutamine were examined and compared in the three groups. RESULTS: The rats on the glutamine-free diet had significantly lower mucosal wet weight, protein and DNA content, and number of intraepithelial lymphocytes on the 7th day, whereas the number of mitoses in the Lieberkuhn's crypts was significantly less on the 28th day. The height of the enterocytes and villi was 20% higher on average in the glutamine-free group. Electron microscopy revealed either early (swelling of cristae) or terminal (swelling of matrix) mitochondrial degenerative changes, homogenization of apical cytoplasm, and degeneration and fragmentation of microvilli with loss of their rootlets. The Na+, K(+)-ATPase activity was markedly decreased in the glutamine-free group compared with that of the other groups, most likely because of a diminished energy supply. Among brush border membrane enzymes, lactase activity decreased markedly (p < .05) in the first week. The glutamine-free diet resulted in an increase of the lung glutamine synthetase activity and decrease in muscle glutamine content by the 28th day of the diet. CONCLUSIONS: Our study shows for the first time that a complete enteral diet, deficient only in glutamine, is associated with significant early morphologic and functional changes in the small intestine. The precise effect on intracellular events and the time of onset of these changes needs to be clarified in the future.

Does primary salt wasting occur in 11-beta-hydroxylase deficiency?

Renal salt wasting secondary to 11-beta-hydroxylase deficiency (11-beta-OHD) has been described in a few patients. This report describes an infant with 11-beta-OHD initially thought to be in adrenal crisis with renal salt wasting. Subsequently the sodium loss was found to be due to a secretory diarrhea, and this prompted us to critically review the literature of the previous case reports. In none has the entity of renal salt wasting secondary to 11-beta-OHD been unequivocally confirmed. The entity should remain in doubt until proven by appropriate studies in the future.

Loperamide for treatment of acute diarrhoea in infants and young children. A double-blind placebo-controlled trial.

High-dose loperamide reduces stool output and shortens the duration of diarrhoea in infants receiving intravenous fluids for rehydration, but may cause potentially harmful side-effects in a small number of patients. This double-blind placebo-controlled study was undertaken to assess whether loperamide would shorten the hospital stay of dehydrated children in a rehydration unit. Ninety-one patients with acute dehydrating diarrhoea received loperamide and 94 received placebo. The groups were clinically indistinguishable on admission to hospital. There was no difference between groups for the duration of rehydration or the number of treatment failures. The use of loperamide is not recommended in the treatment of infants and young children with acute diarrhoea.

Short-term effect of epidermal growth factor (EGF) on sodium and glucose cotransport of isolated jejunal epithelial cells.

This study was undertaken to assess the short-term effects of EGF on sodium and glucose uptake, glucose metabolism and Na+/K(+)-ATPase activity in isolated enterocytes of rats. Jejunal cells exposed to EGF had a significantly greater total uptake of sodium compared to controls after 6 min. Kinetic analysis of glucose transport across BBMV's demonstrated similar Km values but a significant increase of the Vmax in vesicles prepared from cells first exposed to EGF as compared to controls. EGF was also associated with a significant increase in glucose metabolism of jejunal enterocytes after 15 min. The activity of Na+/K(+)-ATPase increased in jejunal enterocytes exposed to EGF. The increase in Na+/K(+)-ATPase activity of the cells following EGF exposure was not accompanied by an increase in immunodetectable total or assembled Na+/K(+)-ATPase protein. EGF's effect on enzyme activity was abolished by removing NaCl from the incubation solution, and by preincubating the enterocytes with phlorizin prior to addition of EGF. Preincubation with amiloride did not inhibit the effect of EGF on Na+/K(+)-ATPase. The results confirm that EGF promotes uptake of both sodium and glucose by the jejunal mucosal cells, and suggest the effect of EGF on glucose and sodium is mediated through the brush-border membrane glucose-sodium transporter. The increase in Na+/K(+)-ATPase activity that occurs with EGF appears to be secondary to a rise in intracellular Na+ concentration. The short-term effects of EGF on glucose and sodium transport by the small intestine may have potential therapeutic implications.

Coxarthrosis and femoral neck fracture.

A retrospective cross-sectional study of the roentgenograms of 300 hip fracture patients and 300 age- and gender-matched controls was performed to determine the relationship between fracture type, femoral neck trabecular bone integrity (as measured by the Singh index), osteoarthrosis, and age. Coxarthrosis was associated with a low incidence of intracapsular fracture but unchanged rates of extracapsular fracture. Singh grade declined with age in all groups of patients, although the rate of decline was reduced in control female patients with coxarthrosis compared with other diagnostic groups. When the coxarthrosis patients were included, the mean Singh grade for the female fracture patients was significantly reduced in patients compared with controls with or without age adjustment (3.88 versus 4.17). When patients with coxarthrosis were excluded from the analysis, this effect disappeared. It is suggested that the differences in Singh grades observed previously between femoral fracture patients and controls may have resulted from an undetected negative association between coxarthrosis and retention of trabecular integrity with aging.

The fundal pile: bleeding gastric varices.

Bleeding from esophageal varices is a common cause of major upper gastrointestinal tract blood loss in children with portal hypertension but usually ceases spontaneously or is satisfactorily managed by nonoperative measures. Massive hemorrhage from gastric fundal varices may be difficult to control with compression and sclerotherapy; in these cases, a direct surgical approach may be indicated. Since 1984, 27 children have undergone aggressive injection sclerotherapy for bleeding esophageal/gastric varices. Nine (6 with portal vein thrombosis) bled from gastric fundal varices. In 5 of these, medical management and sclerotherapy failed to control the acute bleed. In all 5 there was "rupture" of a large gastric fundal varix or "pile" and bleeding was controlled at emergency laparotomy by underrunning the varices through a high anterior gastrotomy. Four have subsequently been successfully managed by continued sclerotherapy and one patient with cirrhosis has died of liver failure. In 3 of the survivors both esophageal and gastric fundal varices have been completely obliterated. No further life-threatening hemorrhage has occurred in any case during a follow-up period of 1 to 5 years. Bleeding from gastric varices is more common than previously recorded and more difficult to control by nonoperative management, including injection sclerotherapy. In uncontrolled hemorrhage from gastric varices, surgical underrunning offers a means of providing initial control. Thereafter, the inevitable variceal recurrence may be successfully treated with sclerotherapy.

Endoscopic sclerotherapy for control of bleeding varices in children.

Thirty-three children with esophageal varices due to portal hypertension underwent injection sclerotherapy over a period of 6 yr. Thirty-one completed the sclerotherapy course, and the varices were eradicated in all. In nine, the procedure was performed as an emergency because of continued bleeding and, in each case, a gastric fundal varix was the source of the blood loss. Sclerotherapy successfully controlled the bleeding in four of these, whereas five required surgical underrunning of the fundal varix. After surgery, these five continued sclerotherapy until the esophageal varices were eradicated. Complications included transient pyrexia (39%), retrosternal discomfort (30%), esophageal ulceration (18%), and esophageal stricture (12%). Rebleeding before initial eradication of the varices occurred in 12 patients but, thereafter, was very uncommon and always small in amount. Esophageal varices recurred after initial eradication in 33% of cases but were easily sclerosed with further injections. This study demonstrates that sclerotherapy is effective in reducing bleeding frequency in children with portal hypertension, but emphasizes the need for regular follow-up endoscopy after initial eradication of esophageal varices.

A new direct pancreatic function test in pediatrics.

Traditional methods for collecting duodenal fluid are time consuming and technically difficult. A simple endoscopic method is proposed in this report as a means of collecting duodenal fluid to perform exocrine pancreatic function tests. Thirty-five patients between 24 and 36 months of age were studied for pancreatic exocrine function. Twenty-seven presented with chronic diarrhea and 8 with failure to thrive. In 20 patients (group 1), duodenal fluid was collected by means of a double-lumen tube and sequential administration of pancreozymin (PZN) and secretin (SEC). The rest (group 2) had duodenal aspiration from the level of the papilla of Vater through a fiberoptic endoscope following administration of SEC only. The procedure took approximately 3 h in group 1 and 45 min in group 2. Secretin administration produced comparable levels of enzymes in both groups. Pancreozymin produced the highest enzyme levels, but this was only significantly higher than SEC-induced levels in the case of lipase. Endoscopic collection of duodenal fluid following SEC administration is a safe, quick, and reliable method of collecting pancreatic secretion.

Dietary manipulation for treating infants with prolonged dehydrating diarrhoea: a comparison of four different formulae.

Dietary manipulation is often the first step in the treatment of infants with persistent acute dehydrating diarrhoea. This usually entails elimination of lactose, but other disaccharides or whole protein may be causing the disease. Serial elimination of these takes time and it may be preferable to use a whole protein and disaccharide-free formula as the first feed change. This study assessed the effect on stool weight of a change from cow's milk formula feeds to one of four different formulae in infants with severe diarrhoea persisting after 3 days in hospital. Two feeds were lactose-free soy formulae containing sucrose, one was disaccharide-free soy formula and one a disaccharide-free protein hydrolysate. Regardless of which feed the infants received, diarrhoea resolved in approximately 50% following the change in diet. Comparing those who got better with those who did not, the former were generally better nourished and had an initial lower stool output, but it was impossible to predict on clinical grounds which individual would respond to the removal of cow's milk. The results suggest that elimination of lactose in infants with persistent severe diarrhoea will benefit a significant number in the early stage of the disease. As there is no additional benefit from eliminating sucrose or whole protein at this stage, the cheapest available lactose-free formula should be used initially.

Cholestatic disorders of infancy--aetiology and outcome.

The relative frequency of causes of cholestatic disorders of infancy in a developing area was established in a prospective study. During a 10-year period, 145 infants with conjugated hyperbilirubinaemia were investigated. Intrahepatic disorders accounted for 68 per cent with no identifiable cause (idiopathic hepatitis) in the majority. Syphilis, urinary tract infection and septicaemia together made up 30 per cent of intrahepatic causes with metabolic disorders accounting for 12 per cent. Outcome in those with idiopathic hepatitis, and those treated for syphilis and UTI was relatively good. Complete recovery from syphilitic hepatitis on average took 11 months. Extrahepatic disorders occurred in 32 per cent and were almost entirely due to biliary atresia. Results of hepatic portoenterostomy for biliary atresia were poor because of late referral in many instances. Compared to developed countries, infantile cholestasis in developing areas is more commonly associated with treatable bacterial infection. Referring agencies should be aware of this fact and the need for early referral of cases with possible biliary atresia.