Trace element pattern in patients with fibromyalgia.

An imbalance of the trace element status in human tissues and body fluids has been suggested as a contributing factor for the development of fibromyalgia (FM). The study comprised 38 females with defined fibromyalgia (FM) according to generally accepted criteria from the American College of Rheumatology (ACR). They were compared with 41 females matched for age and geographic location. The concentrations of about 30 trace element and ions were determined in whole blood, urine and drinking water of all participants by inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectroscopy (ICP-OES). Significantly higher concentrations in whole blood of Cd, Co, Cu, Fe, Se, Sn and Zn (p< or =0.046) were observed in the FM-cases in comparison with the referents. A different pattern was noted in urine with increased urinary excretion of Ag (p=0.003) among the FM-patients. The urinary excretion of the other elements were of the same magnitude or slightly lower in FM-cases as compared to referents. As nearly all of the concentrations of the studied elements in blood and urine were within reported reference intervals in non-occupationally exposed populations, the clinical significance of the differences observed seems to be limited. The element concentrations of the studied elements in drinking water were within present national and international guideline values (EU, WHO) and the concentrations of potentially toxic metals such as e.g. Cd, Hg and Pb were low. In conclusion, the present investigation could not demonstrate abnormal levels of trace elements in blood or urine of FM-patients and, thus, does not support the hypothesis that trace element abnormalities play a significant role in the development of FM.

Staining of granulopoietic agar colonies with a modified Papanicolaou technique.

The aceto-orcein method of staining agar cultured granulopoietic marrow cells has not been entirely satisfactory. In staining whole colonies the original colony structure is lost and the colony cells have blurred cytoplasm. A slight modification of the Papanicolaou technique used for staining vaginal smears improved the quality of stained granulopoietic agar preparations. Smeared Papanicolaou stained colony cells could be compared with smeared ordinary Giemsa stained blood and marrow cells. The Papanicolaou method enabled staining of agar colonies without manipulation of the original colony structure. The preparations of transferred intact colonies had cells with distinct cytoplasm and clear cellular outlines and a background without disturbing masses of stained agar.

[Despondent voices on Swedish pain care: "Situation feels depressing, I have considered to quit my work as pain specialist"]. / Uppgivna röster om svensk smärtvård: "situationen känns dyster, jag har övervägt att sluta som smärtläkare".

The number of patients handicapped by chronic pain is increasing in Sweden. Many of these patients do not receive adequate care despite guidelines issued in 1994 by the National Board of Health and Welfare recommending councils to establish multidisciplinary pain teams according to the guidelines issued by the International Association for the Study of Pain. A survey of Swedish general hospitals reveals that these recommendations have not yet been implemented. With the exception of university hospitals only one out of five hospitals has set up specialised pain care teams; in remaining hospitals the organisation of pain management leaves much to be desired.

Group therapy for somatization disorders in primary care: maintenance of treatment goals of short cognitive-behavioural treatment one-and-a-half-year follow-up.

OBJECTIVE: The objective of this study was to evaluate the maintenance of treatment goals of a short cognitive-behavioural group treatment programme for the management of somatization disorders in primary care. METHOD: In a previous controlled 6-month follow-up study, patients with somatization disorders (n=32) improved with respect to illness and somatic preoccupation, hypochondriasis, and medication usage. In the present report the same group of patients were also investigated one-and-a-half year after initial treatment. RESULTS: The long-term follow-up manifested maintained improvement with respect to hypochondriasis. There was additional reduction of anxiety and psychosocial preoccupation, whereas somatization and depression-anxiety scores improved progressively. CONCLUSION: A short cognitive-behavioural group treatment of psychosomatic patients can be useful in primary care and may manifest maintained or progressive beneficial outcome.

Group therapy for somatization disorders in general practice: effectiveness of a short cognitive-behavioural treatment model.

The objective of this study was to evaluate the effect of a short cognitive behavioural group therapy programme for somatization disorder in primary care. The treatment model was focused on patient education and stress relaxation. A controlled and prospective study design was used with repeated assessments of the patients' perception of their psychosocial problems, psychological distress and medication usage. The results were analysed up to 6 months after treatment and showed the treated patients to be moderately but significantly improved with respect to physical illness and somatic preoccupation, hypochondriasis, and medication usage. In a control group of untreated patients no such improvements were observed. In summary, the short group treatment programme used in this study may be beneficial for patients with somatization disorders. With some modifications it might be useful to practitioners in primary care for the management of psychosomatic disorders.

Studies on hemopoietic dysplasia (the preleukemic syndrome). Clinical course and prognostic factors in 42 patients with dysplastic bone marrow.

The clinical course of 42 patients with hemopoietic dysplasia diagnosed during 1974-77 has been studied. The clinical, laboratory and morphological findings at presentation were investigated for prognostic significance. At the time of completion of the study (Aug. 1979), 38% had developed acute leukemia (median survival after diagnosis 5 months) and 45% had died of complications (bleeding and infections) due to severe cytopenia (median survival 6 months). An overall malignant course was observed in patients with low platelet count (less than 80 X 10(9)/l), bleedings and severe myeloid maturation defect in the bone marrow (greater than or equal to 30% myeloblasts and promyelocytes). Increased serum vitamin B12 and presence of myeloblasts, promyelocytes and abnormal "monocytoid' cells in the peripheral blood indicated a leukemic termination.

In vitro colony and cluster growth in haemopoietic dysplasia (the preleukaemic syndrome). II. Identification of a maturation defect in agar cultures.

The growth and differentiation of granulopoietic progenitor cells from 15 patients with haemopoietic dysplasia were studied by in vitro culture in agar-gel. After 14 d in culture whole colonies and clusters were transferred to glass slides and were stained with a modified Papanicolaou technique. The preparations were examined for cellular differentiation by counting the number of mature cells (band forms and polymorphonuclear cells) and a mitotic index was calculated from the number of mitotic cells. Patients with defective colony formation showed granulopoietic maturation defects and a reduced mitotic index was found in some colonies. Patients who had colony counts within the normal range, however, showed normal in vitro maturation. Defective colony growth in haemopoietic dysplasia generally indicates a malignant course and can occasionally be related to leukaemic transformation. The finding of in vitro maturation defects in an additional culture abnormality which may indicate a deteriorating clinical course. A defective maturation and a reduced mitotic index in vitro add support to the concept of clonal progression in malignant haemopoietic dysplasia.

Progression of bone marrow abnormalities in malignant hemopoietic dysplasia. Evaluation of cytological changes with serial bone marrow samples.

Progression of bone marrow abnormalities in 12 patients with malignant (fatal) hemopoietic dysplasia (HD) was evaluated retrospectively in sequential bone marrow samples, using a simple morphological scoring technique. Special attention was paid to alterations in cytological abnormalities in the myeloid series. Patients who developed acute myeloid leukemia showed increasing scores during the clinical course and a rapid final increase in particularly myeloid nucleolar abnormalities. Patients who did not develop overt myeloid leukemia but died from bleeding and/or infection had low and stable scoring and showed no progression of cytological abnormalities. Repeated evaluation, especially of cytological changes in the bone marrow, and morphological scoring might be useful as predictive tools to estimate the risk of a leukemic transformation in some patients with HD.

Benzodiazepine prescribing patterns in a high-prescribing Scandinavian community.

Sales statistics indicate large variations in benzodiazepine consumption between the Scandinavian countries: the current difference between Denmark (highest) and Sweden (lowest) is almost two-fold. There are also large within-country variations: e.g. benzodiazepine sales in the Swedish city of Helsingborg, which is close to Denmark, were at the average Danish level and were the highest in Sweden. Repeated prescription analyses were carried out in Helsingborg, and register data were used to compare the extent of psychiatric morbidity and psychosocial problems in this city with those in neighbouring cities. Benzodiazepine consumption was higher than the national average in all age groups. However, neither the choice of the predominant benzodiazepine agents nor the dose size or number of doses per prescription showed any major deviation. Hence, Helsingborg may have a larger proportion of benzodiazepine users or longer exposure periods among users. The latter is supported by the fact that about 40% of all benzodiazepine prescriptions were repeated. Psychiatric morbidity, suicide rate, alcohol-related diseases, unemployment and the proportion of socially isolated subjects were higher than the county average. On the other hand, within the county, there were cities that despite lower benzodiazepine sales had an equal or higher rate of suicide, unemployment and alcohol-related diseases. Of all benzodiazepine prescriptions processed in Helsingborg, > 30% were issued by < 5% of the prescribers (> or = 15 prescriptions per prescriber and per week). Thus, the higher usage of benzodiazepines in Helsingborg may partly be related to higher psychiatric morbidity and more psychosocial problems, but deviant prescribing habits among a minority of physicians are also important.