Comparison of budesonide and beclomethasone dipropionate for treatment of asthma.

Beclomethasone dipropionate (BDP) and budesonide (BUD) were each given in a dose of 200 micrograms twice daily by metered dose inhaler to 10 asthmatic children already dependent on treatment with steroids. In a double blind randomised crossover study each course lasted one month. No clinically important differences were found between the two treatments when symptom scores, symptom free days, additional use of salbutamol, and results of lung function tests were considered. Metyrapone mildly reduced the plasma concentration of 11-deoxycortisol in two patients during treatment with budesonide, and in four during treatment with beclomethasone. It is concluded that although they are usually safe, both drugs may cause mild adrenal suppression when given in a dose of 200 micrograms twice daily.     

Duration of action of sodium cromoglycate on exercise induced asthma: comparison of 2 formulations.

Thirteen asthmatic children aged 9-14 years participated in a double blind randomised trial to compare the effectiveness and duration of action of 2 formulations of sodium cromoglycate; one a 20 mg capsule of powdered sodium cromoglycate delivered by turbo inhaler (spinhaler), and the other 1 mg of aerosolised sodium cromoglycate delivered by pressurised cannister inhaler (aerosol). The children performed exercise tests on each of 3 days in a 10 day period--15 minutes, 2 hours, and 6 hours after inhalation of powder, aerosol, or a placebo. Two patients were not protected from exercise induced asthma by either formulation of sodium cromoglycate. Among the remaining patients both formulations gave good protection from exercise induced asthma 15 minutes after inhalation, and the effect of both wore off steadily over the next 6 hours. The spinhaler gave appreciably better protection than the aerosol at 15 minutes after inhalation, and was the only formulation to provide good protection at 2 hours and 6 hours. The more limited effectiveness of the aerosol may be explained by the lower dose of sodium cromoglycate and the more complicated inhalation technique required.     

Determinants of bone density and prevalence of osteopenia among female runners in their second to seventh decades of age

This is a cross-sectional study of spine and hip bone density (BMD) in 124 female athletes, aged 16–68 years, who trained for at least 3 hs/week. The aim was to document the effects of competitive running on BMD in women over a broad age range. Thirty-three subjects, aged <35 years, were currently oligo- or amenorrheic and, of the 50 who were >40 years, and who were now menstruating normally, 13 had previously been oligo- or amenorrheic. Fifty-two women <50 years of age had never had disturbed menses. Twenty-four older women were postmenopausal. Women who had never had menstrual disturbance had significantly increased bone density at the lumbar spine, femoral neck, and femoral trochanter, as compared with young normal European reference data (range from +0.4 population SD or T-score units to +1.2 units according to measurement site and age group). In contrast, young amenorrheic or oligomenorrheic runners had reduced bone density, particularly at the spine (mean T score < −1.1), whereas older runners who previously had disturbed menses, but were now menstruating normally, had bone densities that were similar to sedentary young controls. Postmenopausal runners had bone density values that differed little from sedentary postmenopausal controls matched for time since menopause, after adjusting for the runners’ lower body weight. Bone density outcomes were related to candidate explanatory variables. After taking into account the other variables, age, per se, influenced only the femoral neck and Ward’s area. Years since last exposure to estrogen (at premenopausal levels) was an important determinant of bone loss at both hip and spine. Body weight had a beneficial influence on the femoral neck region, whereas (in contrast) height had a positive influence on the lumbar spine. Months of breastfeeding (totaled for all children) had a modest, positive influence, which was larger in the femoral measurement sites. There was no evidence of an effect of calcium intake or percent body fat on BMD at any site independent of these other effects. It is concluded that, with the consistent presence of normal premenopausal estrogen levels, running at least 3 hs/week substantially improves bone density, particularly at the proximal femur. This beneficial effect is reversed in the absence of the consistent past and current presence of normal menstrual function. There was no clear benefit of running seen on BMD in postmenopausal women, but premenopausal veteran athletes who started running after the age of 30 years were not disadvantaged compared with early starters.     

Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literature

Hughes (antiphospholipid) syndrome (APS) can mimic multiple sclerosis (MS). We analyzed the clinical, laboratory, and imaging findings of MS-like expression in a cohort of patients with APS in an attempt to identify parameters that might differentiate the 2 entities. We studied 27 patients who were referred to our unit with the diagnosis of probable or definite MS made by a neurologist. All patients were referred to our lupus clinic because of symptoms suggesting an underlying connective tissue disease, uncommon findings for MS on magnetic resonance imaging (MRI), atypical evolution of MS, or antiphospholipid antibody (aPL) positivity. aPL, antinuclear antibody (ANA), anti-dsDNA, and anti-extractable nuclear antigen (ENA) antibodies were measured by standard methods. MRI was performed in every patient and compared with MRI of 25 definite MS patients who did not have aPL. An index severity score was calculated based on the size and number of increased signal intensity areas in MRI. In the past medical history, 8 patients with primary APS and 6 with APS secondary to systemic lupus erythematosus (SLE) had had symptoms related to these conditions. Neurologic symptoms and physical examination of the patients were not different from those common in MS patients. Laboratory findings were not a useful tool to distinguish APS from MS. When MRI from APS patients was compared globally with MRI from MS patients, MS patients had significantly increased severity score in white matter (p < 0.001), cerebellum (p = 0.035), pons (p < 0.015), and when all areas were taken together (p < 0.001). Patients with APS had significantly increased scores in the putamen (p < 0.01). No differences were noticed in the degree of atrophy. When taken individually, MRI from APS patients could not be distinguished from MRI from MS patients. Most of the patients with primary APS showed a good response to oral anticoagulant treatment. In patients with secondary APS, the outcome was poorer. Hughes syndrome (APS) and MS can be difficult to distinguish. A careful medical history, a previous history of thrombosis and/or fetal loss, an abnormal localization of the lesions in MRI, and the response to anticoagulant therapy might be helpful in the differential diagnosis. We believe that testing for aPL should become routine in all patients with MS.     

An approach to analysis of large-scale correlations between genome changes and clinical endpoints in ovarian cancer

This report describes analyses of associations of genome copy number abnormalities in ovarian cancers with clinical features using genome-wide graphical and analytical procedures. These studies show that tumor grade is a better indicator of the extent of genomic progression than stage, that loss of chromosome 4 occurs preferentially in high-grade tumors, and that gains of 3q26-qter, 8q24-qter, and 20q13-qter occur frequently in low-grade and low-stage tumors and thus may be early events in ovarian cancer development. In addition, loss of chromosome 16q24 and a total number of independent genome copy number aberrations >7 are associated with reduced survival duration. The association of loss of 16q24 (D16S3026) with decreased survival duration was confirmed by quantitative PCR. Regions that frequently are abnormal and associated with altered survival duration are strong candidates for higher resolution analysis and gene discovery and may be useful markers for prediction of clinical outcome.