Selective viral immunosuppression of the graft-versus-host reaction.

Graft-vs.-host (GVH) reactivity of parental lymph node (LN) cells was assayed by measurements of 3H-thymidine incorporation in vivo in spleens of irradiated F1 recipients. Preincubation of parental LN cells with vesicular stomatitis virus (VSV) for 2 h at 37 degrees C followed by washing resulted in an 85-90% reduction in splenic radioactivity, as did injection of VSV on days 0-2 after recipients received untreated parental LN cells. In contrast, 3H-thymidine incorporation in the spleens or irradiated F1 hosts was not affected by VSV when F1 bone marrow cells were incubated with the virus. In addition, preincubation of F1 B cells with VSV still allowed these syngeneic B cells to be recruited into proliferation by mitomycin-treated parental LN cells. The inhibitory effect of VSV, thus, seems to be specific for T-cell proliferation. These observations suggest that viral immunosuppression might be capable of being developed into a useful strategy for selective deletion of lymphocytes capable of reacting against histocompatibility antigens and initiating GVH reactions.

Investigation of body temperature as a possible feeding control in the suckling rat.

Under natural conditions, rat pups are deprived of milk only when the dam leaves the nest. At this time the body temperatures of the pups will fall. In this study we have investigated the possibility that lowered body temperature of the pups stimulates behavioral changes in either the pups or the dam, leading to increased milk intake. To study behavioral changes of the pups, the milk intake of warm-fasted, cool-fasted, and fed littermates was compared to 10, 14 and 16 days of age. There was no effect of body temperature on milk intake at any age. To study behavioral changes in the dam, milk release by dams suckling entire cool litters was compared with that by dams suckling entire warm litters. Milk release was not significantly affected by the litter temperature. We conclude that lowered body temperature of suckling rat pups does not cause increased milk intake.

Coexistence of systemic lupus erythematosus and parotid hypertrophy. A case report and literature review.

A patient with systemic lupus erythematosus and marked diffuse bilateral parotid swelling is described. Special staining techniques were required to demonstrate a lymphoplasmacytic infiltrate in the otherwise normal appearing acinar tissue. This finding suggests that a humoral, rather than a cellular, mediated immune process is responsible for the parotid hypertrophy in this patient.

Fibromyalgia in children; diagnosis and treatment.

Fifteen children (16 years and younger, 10 females, 5 males, mean age 13 years) with juvenile primary fibromyalgia syndrome (JPFS) were seen in a private rheumatology practice over two years. This represented 45 percent of the total number of pediatric rheumatology patients. Symptoms included polymyalgias, polyarthralgias, nonrestorative sleep, difficulty concentrating in school and fatigue. Examination revealed typical tender points, absence of joint swelling, synovitis or nodules and absence of neurological findings. Dolorimetry was abnormal and standard laboratory tests were normal. Most of these patients (67 percent) had seen three or more doctors prior to their rheumatological evaluation and not (60 percent) were told they had juvenile chronic arthritis. Other diagnoses offered were "growing pains" (20 percent), hysteria (7 percent) and psychological problems (7 percent). None of the JPFS patients responded to salicylate or other anti-inflammatory medication. Most (73 percent) responded to cyclobenzaprine, mean dose 12.75 mg. (range 5-25 mg. qhs). JPFS is a very common pediatric rheumatologic problem and is confused with other disorders. Reassurance is very important in the therapy since many parents are fearful that their children may have a potentially crippling disorder. Medication, especially with tricyclics, moderate exercise and proper sleep are also mainstays of therapy.

Exacerbation of soft tissue rheumatism by excess vitamin A: case reviews with clinical vignette.

In certain situations, health problems can arise if physicians are not aware of over-the-counter medications and vitamins a patient may be taking in addition to their regular prescriptions. Since many people do not consider OTC drugs to be medications, they often do not relay this information while discussing their medical histories. This article describes how the symptoms of soft tissue rheumatism can become worse if patients ingest an excess amount of vitamin A.

Clinical experiences with post-traumatic fibromyalgia syndrome.

Fibromyalgia syndrome (FS) is a musculoskeletal problem that has become more and more widely recognized. There are three types: primary (PFS idiopathic), secondary (associated with another disorder), and post-traumatic (PTFS). The latter condition, PTFS, is especially intriguing since quite often litigation is involved, and doubt is cast as to whether the patient is actually suffering. Accusations of malingering have been made. A retrospective chart review of 14 PTFS patients was made in an effort to ascertain the likelihood of malingering. Over the past two years, 14 patients (three male, 11 female) were treated for PTFS. The mean age was 37 years for both men and women. All had classic PTFS with a chronic musculoskeletal problem that started immediately after a traumatic event, classic myofascial tender points, poor sleep, and normal standard laboratory tests. Twenty-three per cent went to trial; 77 per cent settled out of court. All were given a monetary award. The vast majority (77 per cent) returned to a rheumatologist for continued treatment, suggesting that patients who meet strict FS criteria are not malingering and are indeed in need of medical help.

Sjogren's syndrome: implications for the primary care physician.

Sjogren's syndrome (SS) is a common immunologically-mediated disorder that will afflict a great proportion of our population in future years. The primary care physician undoubtedly will be confronted with such patients, many of whom will have complaints and findings not generally believed to be due to SS. In this communication, case reports of four patients with SS as well as a literature review are presented. Two patients had presentations that were classic for SS; however, the other two were diagnostic challenges. Emphasis is placed on the atypical and unusual way SS can present so that the primary care physician can more easily make the diagnosis and initiate therapy.