Update on exercise-induced asthma: a report of the olympic exercise asthma summit conference.

Exercise-induced asthma (EIA) can be easily overlooked and underdiagnosed, especially in school children or recreational athletes. It affects individuals of all levels of activity, from recreational sports to competition. This article summarizes the results of the Olympic Exercise Asthma Summit Conference, organized by the Sports Medicine Division of the US Olympic Committee. Making the correct diagnosis of EIA is very important and usually requires some form of pulmonary function testing. Because effective pharmacologic and nonpharmacologic treatment is available for this condition, patients should be followed until the condition is controlled.

Anterolateral rotatory instability of the knee. An analysis of the Ellison procedure.

In an attempt to correct anterolateral rotatory instability of the knee, 30 consecutive patients underwent a surgical procedure similar to that described by Ellison (Ellison AE: A modified procedure for the extra-articular replacement of the anterior cruciate ligament. American Orthopaedic Society for Sports Medicine Symposium, New Orleans, LA, July 15, 1975), called the iliotibial band transfer. Fashioning the passageway for the transfer closer to the attachment of the fibular collateral ligament on the femur and meticulous fascial closure over the transplant were not found to be crucial to success. Twenty-nine of the 30 patients were injured during athletic activities, and the remaining patient was injured in a motorcycle accident. They often complained of an unstable knee with symptoms of pain and giving way. Twenty-eight patients with a minimum followup of nine months (the average followup was 25 months) were evaluated subjectively by an interview and by objective clinical examination. Subjective results (including asymptomatic return to their previous level of athletic activity) and clinical improvement of anterolateral rotatory instability (based on the flexion-extension-valgus test or the Slocum anterolateral rotatory instability test) were encouraging. Areas of concern were that a small number of patients developed asymptomatic varus instability and a few had relative strength deficits which may or may not have long-term significance.

Graves' ophthalmopathy.

Graves' ophthalmopathy usually occurs in association with hyperthyroidism. Its occasional occurrence in the absence of thyroid disease suggests, however, that it may be a separate autoimmune disorder. While the evidence supporting an autoimmune pathogenesis is considerable for the ophthalmopathy, it is not so impressive as that for Graves' hyperthyroidism: orbital antibodies have not been convincingly demonstrated and autoantigens have not been identified. On the other hand, in patients with Graves' ophthalmopathy the orbital tissues and eye muscle membranes are infiltrated with lymphoid cells and show evidence of cell-mediated immune reactions. Although there is some evidence that binding of thyroid stimulating hormone fragments and thyroglobulin-antithyroglobulin immune complexes to eye muscle membranes may be important in the pathogenesis of the ophthalmopathy, this needs to be confirmed. The mechanism for the association of hyperthyroidism and ophthalmopathy is unknown, but the association likely reflects an influence of thyroid hormones on the immune system. In view of the autoimmune pathogenesis the logical treatment of Graves' ophthalmopathy appears to be immunosuppression.

Peripheral blood lymphocyte transformation in response to human thyroid fractions in patients with Graves' hyperthyroidism and ophthalmopathy.

Peripheral blood lymphocyte (PBL) transformation in response to human thyroid fractions was carried out in patients with Graves' hyperthyroidism and ophthalmopathy. The fractions used were, an extract, a soluble (cytosol) fraction, and membranes prepared by differential centrifugation at (i) 6500 x g (mitochondria), (ii) 10 000 x g (plasma membranes as used in the radioreceptor assay for thyroid stimulating antibody (TSAb) and (iii) 40 000 x g (microsomes). Results were expressed as stimulation indices (SI). Mean SI for patients were significantly increased compared with those for normals for cytosol and mitochondria but not the other fractions. Taking the upper limit of normal as mean +2 SD for normal subjects for each fraction, positive tests were found in 12 of 35 patients tested. This was in response to extract in 3 of 32 patients, to the soluble fraction in 10 of 31 patients, to mitochondria in 2 of 13 patients, to plasma membranes in 1 of 33 patients, and to microsomes in 1 of 27 patients. Positive tests were associated with hyperthyroidism but not ophthalmopathy.

In vitro production of thyroid-binding antibodies by peripheral blood lymphocytes from patients with Graves' disease: nonspecific responses associated with culture supernatant proteins.

Peripheral blood lymphocytes from patients with Graves' disease were cultured for 7 days with mitogens (phytohemagglutinin, Concanavalin A, protein A), or specific antigen (thyroid membranes), in an attempt to produce thyroid-binding antibodies (TBAb) in vitro. TBAb was measured in culture supernatants using a sensitive radioreceptor assay. Mean TBAb indices of mitogen or antigen-stimulated cultures did not differ significantly from those of unstimulated cultures for either patients or normal subjects. Although TBAb indices of less than 0.70, which are generally considered positive for serum TBAb, were demonstrated in a small proportion of individual tests of supernatants from patients with Graves' disease, low indices were also found in tests from normal subjects. One cause of such nonspecific responses was found to be culture infection. The factor associated with positive responses in infected cultures was unlikely to be an immunoglobulin since TBAb-like activity was not detected in globulins isolated by DEAE + -Sephadex chromatography, which isolates only IgG and IgA, and the activity was not neutralized by anti-IgG serum. The possible ways of improving the culture system for in vitro TBAb production and the significance of nonspecific responses in the radioreceptor assay are discussed.