The serum selenium concentrations in children and young adults: a long-term study during the Finnish selenium fertilization programme.

OBJECTIVE: To investigate the effects of the Finnish nationwide selenium (Se) fertilization programme on the Se status of the population. DESIGN AND SUBJECTS: Serum Se concentrations from 1985-1992 from 1568 healthy children and young adults in southwestern Finland were determined using direct electrothermal atomic absorption spectrometry. RESULTS: The mean concentration in young adults increased from 1.04 micromol/L in 1985 to 1.59 micromol/L in 1990. Children younger than 15 y had lower concentrations than adults, with an increase from 0.87 micromol/L in 1985 to 1.31 micromol/L in 1990. The younger the children, the lower the Se concentrations tended to be. At the age of about seven months no significant difference was noted between breast-fed and formula-fed infants. From 1991, when the amount of Se added to fertilizers was reduced and less foreign high-Se cereal was imported, the Se concentrations decreased in all age groups. CONCLUSIONS: The nationwide Se supplementation programme has succeeded in elevating the Se intake and the serum Se concentrations in the Finnish population.

Serum selenium, zinc and copper in Swedish and Finnish orienteers. A comparative study.

Serum selenium, zinc and copper concentrations of 127 highly-trained Swedish orienteers have been analysed and compared with the corresponding values of 30 elite Finnish orienteers, and those of 111 healthy Finnish medical students. The mean serum selenium levels of Finnish orienteers, 1.35 mumol l-1, and students, 1.38 mumol l-1, were statistically significantly higher than those of Swedish orienteers, 1.09 mumol l-1. The serum levels of selenium were lower than 1.0 mumol l-1 in 27% of Swedish orienteers. This is obviously due to the lower selenium intake of the population in Sweden, where the soil selenium content is known to be low. Serum levels of zinc were within the reference interval in both Swedish and Finnish orienteers (mean values 14.8 and 14.1 mumol l-1, respectively). However, Finnish students had significantly lower serum levels of zinc, 12.5 mumol l-1. The mean serum concentration of copper was statistically significantly higher in females than in males.

Effect of nationwide selenium supplementation in Finland on selenium status in children with juvenile rheumatoid arthritis. A ten-year follow-up study.

A study was performed on the effect of increased selenium intake on the serum selenium level of 212 children with juvenile rheumatoid arthritis (JRA) and of 214 controls in a follow-up study during the Finnish nationwide selenium fertilization programme, which was started in 1984. The mean serum level of selenium increased from 0.90 mumol l-1 in 1985 to 1.56 mumol l-1 in 1990 in the children with JRA. The corresponding selenium levels in the controls were 0.87 mumol l-1 in 1985 and 1.33 mumol l-1 in 1990. Boys had slightly higher selenium levels in all the age groups among the patients and the controls. During the entire 10-year observation period, the patients with JRA had slightly higher mean levels of selenium than the controls. The age of the children did not have any significant effect on the selenium level in either group. The present study shows that the main factor affecting the serum level of selenium was the dietary intake of selenium both in patients and in healthy controls.

Environmental effects of nationwide selenium fertilization in Finland.

To study the possible pollution of natural waters by selenium added to agricultural fertilizers, water selenium concentrations were determined in lakes and ground water pools during the year 1992, when the enrichment of fertilizers by selenium had continued for 8 yr. Water samples were preconcentrated by evaporating, and selenium concentrations were analyzed fluorometrically using the dye 2,3-diaminonaphthalene after wet digestion. In lake water samples from 13 lakes, no significant correlations were found between selenium and pH, chlorophyll A, total nitrogen, or phosphorus. Agriculturally affected and nonaffected lakes had no differences in their selenium concentrations. In the lakes that were surrounded by cultivated fields mean water selenium was 83.4 ng/L (range: 75.2-93.4 ng/L, n = 9). Correspondingly, in lakes situated in forests without agricultural surroundings, mean water selenium concentration was 76.5 ng/L (range: 51.2-110 ng/L, n = 3). Only one lake in the close vicinity of a coal power plant had a high water selenium concentration (mean 272 ng/L). In ground water samples, there was a big variation in selenium levels between different pools, the levels varying between 33 and 260 ng/L. This variation may partly be explained by different selenium concentrations of the bedrock and sediments. However, simultaneous increase of total nitrogen, phosphorus, and selenium levels in consecutive samples from some ground water pools indicates leaching of selenium from the fertilizers into the ground water in certain areas.

Serum selenium levels in diabetic children. A followup study during selenium-enriched agricultural fertilization in Finland.

The effect of increased selenium uptake on serum selenium in diabetic children was investigated during the first 9 yr of the Finnish nationwide selenium fertilization program, which started in 1984. Serum selenium concentrations were followed in 237 diabetic children (mean age 8.1 yr) and 214 controls from 1984 to 1992. The control group consisted of 107 siblings of the diabetics and of 107 other healthy children of corresponding age groups. Selenium was determined by direct electrothermal atomic absorption spectrophotometry. The effect of the increased uptake was seen in both diabetic and in control persons. Before the autumn of 1985, diabetic patients had significantly higher serum selenium levels than their siblings or the other healthy controls. Toward the end of year 1987, this difference had disappeared. After that, serum selenium levels continued to increase until the year 1990. In 1990 the mean selenium serum level of diabetic patients was 1.36 mumol/L and that of controls 1.33 mumol/L. The duration of diabetes did not have any effect on selenium serum levels. Slightly higher serum selenium in new diabetic patients before the start of therapy was explained by the dehydration state. The patients who were younger than 3 yr had slightly lower selenium serum levels when compared with older age groups. This difference was observed, however, only during the first 3 yr of the study. After that, when the selenium intake increased in general, no age-dependent differences were found anymore. There were no significant differences in serum selenium levels between males and females in either diabetic patients or in controls.

Incidence of systemic connective tissue diseases in children: a nationwide prospective study in Finland.

OBJECTIVE: To study the incidence of systemic connective tissue diseases (CTD) and of systemic onset juvenile arthritis (S-JA) in children aged 0 to 15 years. METHODS: A nationwide, prospective, hospital based series of new patients from Finland collected during a 4-year period and supplemented with data from the National Hospital Discharge Register. The population at risk was 1.02 million. Classification criteria developed for adult CTD and the American Rheumatism Association criteria for JA were used. RESULTS: The annual incidence rates found were as follows: systemic lupus erythematosus 0.37, polymyositis/dermatomyositis (PM/DM) 0.30, mixed connective tissue disease 0.10, scleroderma 0.05, and S-JA 0.47/100,000. Girls outnumbered boys in the whole series of CTD (24:9) and also in S-JA (11:8), but in PM/DM the sex distribution was even. CONCLUSION: CTD and S-JA are rare before the age of 16 years. From the present incidence figures and those recently published for JA the incidence of CTD is estimated to be between 4 and 7% of that of JA, and S-JA accounts for only 2 to 4% of all JA.

The effect of nationwide selenium enrichment of fertilizers on selenium status of healthy Finnish medical students living in south western Finland.

In Finland commercial fertilizers have been enriched with sodium selenate since July 1, 1984 in order to compensate for the poor selenium content of the soil. Fertilizers that are used for the production of hay and fodder were supplemented with 6 mg/kg of selenium, whereas fertilizers used for the production of cereals were supplemented with a higher dose, 16 mg/kg fertilizer. The effects of selenium fertilization were first seen in diary products in June 1985, and from the beginning of August 1985, the effect was evident also in wheat flour, beef, and bovine liver. In this study the selenium status of 108 healthy young adults has been systematically documented since November 1985, at which time the mean selenium serum level (S-Se) was 1.05 umol/L. A steady increase was observed until November 1989, when the maximum level, with a mean of S-Se 1.6 umol/L was reached. After that, a slight decrease has occurred. The mean serum selenium level in autumn 1991 in a new group of 35 students was 1.58 umol/L. This decrease can be explained by the high amount of imported cereals in 1988 and 1989, which was reflected also in the serum selenium levels. The glutathione peroxidase activity in erythrocytes in 1989-1990 was at the same level as in 1985 and 1986.

Effect of conventional dose growth hormone therapy for two years on height velocity and height prognosis in girls with Turner syndrome.

The aims of this national multicentre study in Finland were to evaluate whether the height velocity of patients with Turner syndrome would increase with the conventional human growth hormone (GH) therapy regimen normally given to GH-deficient children and whether girls with Turner syndrome actually show GH neurosecretory dysfunction. Finally, the study should show whether GH therapy improves height prognosis and, eventually, final height. Twenty-five girls with Turner syndrome, aged 7.5-14.4 years, entered the study. Their ability to secrete GH was determined and, surprisingly, several would have been classified as having GH deficiency. All girls received GH, 0.1 IU/kg/day (maximum dose 4 IU/day) s.c., and once over 12.5 years old, they also received oestradiol valerate and fluoxymesterone. They showed a convincing increase in height velocity, and rapid growth continued during the second year of therapy. The effect of GH therapy on final height is still unknown. The therapy was remarkably free of side-effects.

Steady state pharmacokinetics of piroxicam in children with rheumatic diseases.

Ten children with rheumatoid arthritis, aged 7-16 y and weighing 20-63 kg, were treated with piroxicam mean dose 0.4 mg.kg-1 once daily for 2 weeks. On Day 15, blood was sampled from 2-120 h after the last dose. The Cmax for piroxicam ranged from 3.6 to 9.8 (mean 6.6) mg.l-1 and its half-life by log linear computation was 22 to 40 (mean 32.6) h. The volumes of distribution and the total body clearance were estimated as the ratio of actual volumes of distribution and actual clearances to availability. The volumes of distribution (V/F) were 0.12 to 0.25 (mean 0.16) l.kg-1, and the total body clearances (CL/F) were 2.1 to 5.0 (mean 3.4) ml.kg-1.h-1. Thus, piroxicam clearance in these patients was higher and its half-life was shorter than those previously reported in young adults, yet V appeared similar.

Technetium-99m nanocolloid scintigraphy in rheumatic inflammation in children.

Technetium-99m HSA (human serum albumin) is a nanometer-sized albumin-based inert colloid, which has a specific ability to accumulate in inflamed soft tissue lesions. With a particle size smaller than 30 nm, Tc-99m HSA spills into the extravascular space in the sites of inflammation because of the changed capillary permeability. The conventional tracer in joint scintigraphy, technetium-99m methylene diphosphonate (Tc-99m-MDP) is a boneseeking compound, which strongly accumulates in the epiphyseal area of growing bones. This makes the estimation of the inflammatory process in the joints of growing children difficult. The nanocolloid compound has not this disturbing tendency. This fact makes the joint scans more specific and the detection of inflammatory lesions is easier especially in children. In our study Tc-99m HSA is used for the detection of rheumatic inflammation in children with juvenile rheumatoid arthritis. We examined 24 children with juvenile rheumatoid arthritis, age 3-19 years, 20 girls and 4 boys, who all had clinically active inflammation in the joints or in the tendon sheets. The uptake pattern of nanocolloid parallels the severity of the inflammatory process in periarticular tissues and tendon sheets. In suspicious cases, the comparison with the contralateral area helps in the detection of the lesion. Therefore, when investigating paired joints, the scintigraphy of symmetrical parts is necessary.

Arthroscopic synovectomy in the treatment of patients with juvenile rheumatoid arthritis.

Since January 1982, operative arthroscopy in the knee joint has been performed by us to 22 patients with juvenile rheumatoid arthritis, by whom synovectomy was considered to be indicated. The age of the patients varied from 5 to 16 years. In general anaesthesia, in the connection of arthroscopy, the abrasion of the hypertrophic synovial membrane was made by Stryker's chondrotome. The surgical debris was evacuated by suction. The mobilisation of the knee joint was started 2 days after the operation, and most of the patients walked on the fifth postoperative day. The arthroscopic synovectomy is considered to be a safe operation and, in our opinion, a good alternative method for synovectomy. Rehabilitation time is decisively shorter and, if necessary, operative arthroscopy can easily be repeated, without disturbing scars.

Clinical manifestations of Yersinia pseudotuberculosis infection in children.

The clinical manifestations of infection were analysed during an outbreak of 34 cases of Yersinia pseudotuberculosis serotype Ia infection. The diagnosis was based on the results of enzyme immunoassay and verified by stool culture in five cases. The first four patients were pupils from the same school, and information on any signs and symptoms of infection was obtained by questionnaire from pupils of the school. A blood sample was obtained from 101 children. Strong IgM and IgG antibody responses to Yersinia pseudotuberculosis Ia were found in 13 (25%) of the 52 pupils who reported signs and symptoms of infection and in 9 (18%) of the 49 with no manifestations of infection. The vigorous immune response also resulted in effective opsonization of the causative microorganism. The most common symptoms were fever and abdominal pain. Three children operated on because of suspected appendicitis were found to have mesenteric lymphadenitis. Only one patient developed reactive arthritis. Analysis showed that a remarkable proportion of Yersinia pseudotuberculosis infections may be subclinical, and that individual Yersinia pseudotuberculosis strains may have different capacities to cause postinfection complications.

Mumps infections in the etiology of type 1 (insulin-dependent) diabetes.

The epidemiology of Type 1 (insulin-dependent) diabetes was studied during a period starting after an unusually sharp epidemic of mumps. The number of diabetic cases increased significantly 2-4 years after the epidemic. Incidence rates were highest in geographical areas with the highest incidence of mumps and lowest in areas with the smallest numbers of reported mumps cases. Serological studies employing EIA-assays indicated recent mumps infections more often among newly diagnosed diabetic children than among matched controls although the incidence was low (13% of patients and 4% of controls had serological markers of recent mumps). Those patients, who had had serologically verified recent mumps had more often HLA-DR4 associated risk antigens (Dw4 and Dw14) than other patients. Also clinical history of mumps was obtained more often from diabetic children than from controls as 27% of the patients and 14% of the controls had had clinical mumps during the five years preceding the diagnosis of diabetes. These results confirm several earlier reports suggesting a connection between mumps and Type 1 diabetes and that the onset of diabetes may be delayed by several years.

Serum antibody-bound insulin as a measure of insulin antibodies in diabetic children.

The usefulness of the measurement of serum antibody-bound and total immunoreactive insulin (IRI) concentrations in the assessment of insulin antibodies was evaluated in a material comprising 49 insulin-dependent diabetic children with a mean age at onset of 8.6 years (range 0.8-16 years) treated with highly purified porcine insulins. Serum antibody-bound and total IRI concentrations of individual patients were compared with insulin antibody levels measured with 3 different insulin antibody assays. The correlation coefficients of insulin antibody levels with concentrations of serum antibody-bound IRI ranged from 0.75-0.79. In serum samples with moderate or high insulin antibody levels most of the insulin was in the form of insulin-insulin antibody immunocomplexes. Thereby a very close correlation was found between antibody-bound and total serum IRI concentrations (r = 0.98) in this material. Residual endogenous insulin secretion decreased with increasing duration of diabetes. No significant correlation was found between the duration of diabetes and serum antibody-bound IRI concentrations. High serum antibody-bound IRI concentrations were associated with low glucagon-stimulated plasma C-peptide levels. Although the determination of serum antibody-bound IRI concentrations does not characterize insulin antibodies with regard to binding capacity and affinity constants, it yields information of the actual degree of insulin binding in the circulation. This information may be useful in assessing the benefits of transferring diabetics with high insulin antibody titers from conventional to highly purified porcine or human insulin therapy.

[Characteristics of chronic joint diseases in childhood and adolescence]. / Besonderheiten chronischer Gelenkerkrankungen im Kindes- und Jugendalter.

After dealing briefly with aspects of nomenclature and classification, the author describes the multifarious picture presented by juvenile chronic arthropathies (JCA). Special emphasis is given to the way in which these differ from adult arthropathies, including the clinical syndromes, paraclinical findings, complications, sequels and social integration of patients. A short reference is made to the Morbus Kashin-Beck in view of similarities to JCA polyarthritis.

Determination of ketoprofen by high-performance liquid chromatography from serum and urine: clinical application in children with juvenile rheumatoid arthritis.

A method for the determination of ketoprofen in serum and urine by reversed-phase high-performance liquid chromatography is described. The technique is based on a single extraction of the drug and an internal standard from serum or urine with chloroform. The column was packed with uBondapak C18 and the mobile phase was acetonitrile-water (50:50)(pH 3). The detection limit for ketoprofen was 0.1 mumol/l using 500 microliter of sample. The method described is suitable for routine and pharmacokinetic studies. The results of its clinical application suggest that the pharmacokinetics of ketoprofen in adults and in children are similar.

Nerve conduction velocity in juvenile rheumatoid arthritis.

Motor and sensory nerve conduction velocities (NCV) were recorded in several nerves of a total of 99 patients with juvenile rheumatoid arthritis (JRA), and the results were compared to those obtained for two reference groups, one consisting of healthy children and the other of 30 children with different articular manifestations. The JRA and the affected reference group were not found to differ significantly from each other. NCV values were systematically slightly higher and the distal median nerve latencies slightly shorter in the patients with JRA than in the healthy reference group. Several measurement values differed from each other significantly. Some patients with JRA showed slightly decreased NCVs in individual nerves, but manifest mononeuropathy was not found. The results show that complications of peripheral nervous system origin do not typically occur in association with JRA.