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The role of eosinophilic airway inflammation in the variant asthma syndromes of cough and chest colds is not well defined. We tested the hypothesis that children with persistent cough and chest colds have increased sputum eosinophils, similar to those with wheeze. The parents of 390 primary school children completed a symptoms questionnaire. Children with wheeze (n = 28), cough (n = 12), recurrent chest colds (n = 17), and no symptoms (control subjects, n = 26), underwent allergy skin prick tests, spirometry, hypertonic saline inhalation challenge, and sputum induction, and then completed a peak expiratory flow (PEF) and symptoms diary over a 2-mo period. Children with wheeze had significantly reduced PEF (p = 0.001) and higher sputum eosinophils when compared with the cough, chest cold, and control groups (3.1% versus 0.5%, 0%, 0%; p = 0.03). The prevalence of eosinophilic bronchitis (sputum eosinophils > 2.5%) was 45% in the wheeze group, which was significantly higher than the control group (9.35%, p = 0.04). Eosinophilic bronchitis was present in two children with cough (20%) and two with chest colds (15%, p > 0.05 versus control). In these groups, eosinophilic bronchitis was not associated with airway hyperresponsiveness (AHR) to hypertonic saline (p > 0.05). Children with cough and chest colds reported greater exposure to environmental tobacco smoke. In conclusion, this community-based survey of children with chronic respiratory symptoms has shown that wheeze is a good discriminator for the presence of eosinophilic bronchitis, and that persistent cough and recurrent chest colds without wheeze should not be considered a variant of asthma. Eosinophilic bronchitis did occur in a significant minority of these "variant asthma" syndromes.

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OBJECTIVE: To compare the effects of semi-rigid and soft orthoses worn in supportive shoes, and supportive shoes worn alone, on metatarsal phalangeal (MTP) joint pain. MTP joint synovitis, and lower extremity function in patients with rheumatoid arthritis. METHODS: Twenty-eight subjects referred to occupational therapy received in random order 3 interventions for 12 week trials, separated by 2 week washouts. A crossover design compared effectiveness of interventions. RESULTS: Twenty-four subjects completed the study. A reduction in mean pain scores from baseline to final visits showed that semi-rigid orthoses had a highly significant effect on pain. Soft orthoses did not show a significant effect on pain from baseline to final visit, nor did shoes worn alone. None of the interventions had a significant effect on synovitis or function. CONCLUSION: Semi-rigid orthoses worn in supportive shoes were an effective treatment for metatarsalgia. Supportive shoes worn alone or worn with soft orthoses did not provide pain relief for metatarsalgia.

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OBJECTIVE: To measure preimmunization rubella virus (RV)-specific IgG levels and to relate these to the development of acute and chronic (persistent or recurrent) joint manifestations following rubella vaccination. METHODS: Specific IgG was determined by whole RV enzyme immunoassays (EIA) (Abbott Rubazyme and M33, an in-house method), immunoblot, neutralization domain peptide (BCH-178c) EIA, and neutralization bioassay in prevaccine samples of 268 RV seronegative women (Abbott absorbance < 0.999 units) who had received monovalent live attenuated RA27/3 strain RV vaccine in a clinical trial that recorded joint manifestations. RESULTS: Of rubella vaccinated women tested for prevaccine antibodies, 21.7% were actually positive (> or = 10 IU/ml) by M33 EIA, 33.2% had Abbott values > or = 0.250 units, and 47.6% had RV protein-specific antibody (immunoblot), while only 17.6% were positive (> or = 10 IU/ml) by neutralization domain peptide EIA and 12.7% had neutralization titers > or = 1:8. Seropositivity by the various methods was compared to recorded occurrence of acute and chronic arthropathy (arthralgia and/or arthritis) after RV vaccination. Relative to women who had no joint manifestations, prevaccine seropositivity rates for subjects with acute arthropathy were significantly (p < 0.05) lower in the Abbott test (< 0.250 units), BCH-178c peptide EIA, and neutralization bioassay, while those who also developed chronic arthropathy had significantly lower prevaccine seropositivity rates for the Abbott (< 0.250 units) and M33 EIA and neutralization bioassay. CONCLUSION: Results suggest that risk for arthropathy following RA27/3 rubella vaccination may be higher in women who have very low prevaccine levels of antibody, particularly in assays measuring functional (neutralizing) antibodies.

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The myopathy caused by zidovudine (AZT) appears to be common but is incompletely characterized, particularly regarding prognosis. Twenty patients with HIV infection developed a necrotizing myopathy while taking AZT for 9 to 30 months. Ten presented with myalgia and 17 with proximal muscle weakness. Serum CK was elevated in all (two to 11 times normal), and EMG suggested active myopathy in all but two. There were scattered granular degenerating fibers, with scant or no inflammation, in a pattern consistent with a toxic myopathy in all 18 patients biopsied. Three patients with an HIV-related inflammatory myopathy were distinguished by histologic differences. After stopping AZT (n = 15), myalgia promptly resolved (10 of 10). Strength improved more slowly with 12 of 15 regaining normal or nearly normal strength, but three have persistent weakness. CK returned to normal in 12 of 15, and follow-up EMG (n = 11) documented reduced fibrillation density in all 11 patients. These findings underscore the need for early diagnosis of this reversible myopathy.

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Serial measures of respiratory function were made in 17 patients with Duchenne muscular dystrophy who underwent segmental spine fusion and in 22 patients who did not. No significant differences were observed between the 2 groups (operated vs. nonoperated) in terms of declining respiratory function. Nonetheless, all operated patients reported either improved sitting comfort, appearance, or both. Thus, our results suggest that there are distinct benefits from segmental spine fusion; however, there was no salutary effect upon respiratory function either in the short term or after up to 5 years follow-up.

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Involvement of the central nervous system by human immunodeficiency virus is an important cause of morbidity and mortality. We have undertaken a longitudinal study of asymptomatic individuals found to be human immunodeficiency virus seropositive to identify and characterize cerebrospinal fluid abnormalities early in the disease process. Our findings in 25 individuals have been notable for a frequent incidence of cerebrospinal fluid abnormalities. Pleocytosis or elevated cerebrospinal fluid protein was found in 12 (48%) of 15 patients studied. Oligoclonal banding was present in 6 (26%) of 23 patients. Human immunodeficiency virus was isolated by culture in 4 asymptomatic patients. The cerebrospinal fluid abnormalities we observed indicate an active process occurring in the central nervous system, even in early human immunodeficiency virus infection in asymptomatic patients. Serial observation of these patients for development of neuropsychiatric findings may provide answers to the significance of cerebrospinal fluid abnormalities identified in these patients.

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GPN syndrome with syncope, hypotension, and bradycardia is rare. The association of this syndrome with neck masses mandates that these patients undergo a search for such tumors. A review of the literature and our experience revealed 12 cases of this syndrome associated with neck masses. The majority (60%) of the patients did not respond to medical therapy and eventually required a neurosurgical procedure to cure symptoms. However, medical therapy, including high-dose carbamazepine, should be tried first, particularly in individuals who represent a high operative risk.

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We report a case of chronic progressive inflammatory polyradiculoneuropathy with a subacute exacerbation that included ataxia, tendon areflexia, ptosis, and ophthalmoplegia. Spinal fluid protein was elevated and electrophysiological studies revealed a demyelinating neuropathy. This case suggests a continuum between chronic inflammatory polyradiculoneuropathy and the Miller Fisher variant of acute inflammatory polyneuropathy.

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