Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome.

OBJECTIVES: The pain intensity of patients with FM has recently been reported to be correlated with the degree of small intestinal bacterial overgrowth (SIBO). SIBO is often associated with an increased intestinal permeability (IP). Increased IP, if shown in FM, may have pathogenetic relevance because it leads to the exposure of immune cells to luminal antigens and consequent immune modulation. It is currently unknown whether IP is altered in FM. We therefore examined the IP in a group of patients with primary FM and in two control groups, healthy volunteers and patients with an unrelated chronic pain syndrome, complex regional pain syndrome (CRPS). We hypothesized that patients with FM, but not volunteers or those patients with CRPS, would have altered IP. METHODS: Both gastroduodenal and small IP were assessed using an established three-sugar test, where urinary disaccharide excretion reflecting intestinal uptake was measured using HPLC. RESULTS: Forty patients with primary FM, 57 age- and sex-matched volunteers and 17 patients with CRPS were enrolled in this study. In the FM group, 13 patients had raised gastroduodenal permeability and 15 patients had raised small intestinal permeability, but only one volunteer had increased gastroduodenal permeability (P < 0.0001, chi-square test for the three groups). The IP values were significantly increased in the patient groups (P < 0.0003 for all comparisons, one-way analysis of variance). CONCLUSIONS: The IPs in primary FM and, unexpectedly, CRPS are increased. This study should stimulate further research to determine the implication of altered IP in the disease pathophysiology of FM and CRPS.

Oral health status of kindergarten children in a medium-sized German town near the Czech border.

A cohort examination was performed to investigate the oral health status of 215 kindergarten children in a medium-sized German town near the Czech border. Despite an extensive campaign involving information events and discussions, only 130 of these children could be recruited to participate in the study. They showed a mean caries rate of 50%, which was up to 60% among the 6-year-olds. These findings clearly fall short of the WHO goals for 2000 and indicate that the geographic area covered by the study has a significant oral health deficit. The study also showed a particularly high prevalence of carious defects in a small number of children. The posterior occlusal relations were normal in 90.8 percent of cases. Deformations of the os maxillare (open bite due to finger sucking) were found in 20% of the 4 year group, in 2.3% of the 5 year group, and in 13% of the 6 year group.

[An "atraumatic" universal needle for single-shot regional anesthesia: clinical results and a 6 year trial in over 30,000 regional anesthesias]. / Eine "atraumatische" Universalkanüle für einzeitige Regionalanaesthesien. Klinische Ergebnisse nach sechsjähriger Erprobung bei über 30,000 Regionalanaesthesien.

The so-called "atraumatic" needle was developed by modification of two essential features of the Whitacre Spinal needle. The new atraumatic needle tip is universally suitable for all single-shot techniques of regional anesthesia. This is the result of a 6-year test period with 34,950 applications of 24- and 22-Gauge needles in spinal anesthesia, diagnostic lumbar puncture, peridural anesthesia, plexus anesthesia, peripheral nerve blocks with a Teflon-coated version (unipolar electrostimulation), and lumbar sympathetic and celiac plexus blocks. Postspinal headache was observed following 0.02% of punctures for anesthetic or diagnostic purposes. Transient monosymptomatic nerve damage occurred in 1 case after axillary block (0.009%). No permanent neurological sequelae were observed due to vascular, neural, or dural lesions. In comparison, 10 cases of persistent traumatic nerve damage were reported to be caused by conventional needles during the last decade. An analysis of these cases reveals some reasons for underestimating the risk of neurological sequelae after regional anesthesia. The routine clinical use of this type of atraumatic needle revealed no disadvantages with regard to efficacy of nerve blocks or training of anesthetists. Due to the extremely low incidence of postspinal headache, this needle has been used for spinal therapy and diagnostic lumbar punctures in outpatient pain therapy for 2 years. As of this time, the overall risk of outpatient lumbar puncture cannot be estimated. Our experience should encourage further controlled studies to evaluate criteria for excluding those patients unsuited for outpatient spinal anesthesia and lumbar puncture.

Localization and nucleotide sequence of the gene for the ATP synthase proteolipid subunit on the spinach plastid chromosome.

A 1.6 kbp DNA segment of spinach plastid DNA has been shown to carry the gene for the proteolipid subunit of the ATP synthase. Each plastid chromosome contains one copy of this gene which is located in the large single-copy region of the chromosome near that of the ATP synthase alpha subunit. These two genes are transcribed in the same direction and probably in distinct RNA species. The proteolipid gene was located by hybrid-selection mapping, by transcription/translation of recombinant DNAs and by nucleotide sequencing. The in vitro product was identified by electrophoretic criteria including its characteristic shift in electrophoretic mobility upon incubation with dicyclohexylcarbodiimide, and immunology. The nucleotide sequence of the proteolipid gene is uninterrupted. The deduced amino acid sequence coincides with the published amino acid sequence for this protein and shows little homology with the published sequence of the proteolipid subunit of E. coli.

[Pulmonary fibrosis following ARDS. Case report of successful intensive therapy (author's transl)]. / Lungenfibrose nach ARDS. Kasuistik einer erfolgreichen Intensivtherapie.

The course of the illness of a 56 year old female patient is reported, who is still surviving one and a half years after developing advanced, presumably progressive, so called "shock-lung syndrome". Following two episodes of hemorrhagic shock due to intestinal hemorrhage and post-operative secondary hemorrhage, interstitial lung edema developed, which was resistant to therapy. During the following weeks this was followed by bronchopneumonia with symptoms of sepsis persisting over several weeks. Between the third and seventh week of artificial ventilation X-ray of the lungs showed significant progressive changes of the interstitial tissues. This correlated with a progressive deterioration in gas exchange for O2 and CO2, which reached its peak in the seventh week with a paO2 of 71 mm Hg at a FIO2 = 1 and a paCO2 of 68 mm Hg at a minute volume of 15,51. The compliance of lung and thorax was severely reduced at 19 m1/cm H2O. At this apparently unfavourable time the patient was weaned off the respirator, and subsequently, over a period of three weeks, from oxygen insufflation. After eleven weeks of therapy, transfer to the medical ward was possible, with discharge from the hospital following three weeks later. The lung function tests at the time of discharge revealed a high grade reduction of all lung volumes and capacities without a significant obstructive component. The findings have shown a definite improvement during the following one and a half years. In retrospect the polypragmatic intensive therapy measures do not allow valid generalised therapeutic guidelines to be derived. We conclude, however, from this single observation, that therapeutic nihilism is not justified even in a progressive shock-lung syndrome which appears clinically and radiologically to be at an "irreversible" end stage.

Concentration of vitamin A, retinol-binding protein and prealbumin in serum in response to stress: A contribution to the prevention of stress ulcers by means of vitamin A.

Starting from clinical observations indicating a reduction in the stress ulcer rate by parenteral administration of high doses of vitamin A after burns, traumatic damage and surgical operations, the pattern of vitamin A, retinol-binding protein (RBP) and prealbumin (PA) concentrations in serum was studied in a number of patients with multiple traumas (group 1; n equals 32), cranial-cerebral lesions and postoperative conditions (group 2; n equals 27) and patients having undergone gynecologic operation (group 3; n equals 15); the results obtained were compared with the concentrations determined preoperatively and the normal values as reported in the literature. It was seen that the concentrations in the 3 groups were significantly reduced for all 3 parameters. This fall in concentration was observed not only when food was withheld but also with optimal supplies of essential nutrients. Intestinal hemmorrhages occurred in altogether 6 patients of groups 1 and 2 who exhibited serum vitamin A concentrations in the extremely low range and in the lower normal range.