Dual-energy x-ray bone densitometry was used to study the lumbar vertebral bone mass in 218 healthy children (134 girls and 84 boys) aged 1-19 years. Vertebral bone mass increased with weight, age, and pubertal Tanner stage. Results of multiple regression analyses showed that Tanner stage and weight were the best predictive indicators of bone mass and bone mineral density. The influences of age, sex, race, physical activity, and diet were not significant when Tanner stage and weight were controlled. Two tables of predictive intervals for lumbar vertebral bone mineral density in healthy children (one based on Tanner stage and weight; the other, on age and weight) are presented. With normative data now available for use with this precise technique, clinicians can better detect abnormal bone mineral density in children and evaluate changes in mineralization over time.

Decreased release of nitric oxide from damaged endothelium is responsible for the impaired endothelium-dependent vasodilator responses found in animal models of vascular disease. Dietary supplementation with fish oils has been shown to augment endothelium-dependent relaxations, principally by improving the release of nitric oxide from injured endothelium. Using forearm venous occlusion plethysmography we studied vascular responses to 60, 120, 180 and 240 nmol/min of acetylcholine (an endothelium-dependent vasodilator) and 3, 6 and 9 nmol/min of glyceryl trinitrate (an endothelium-independent vasodilator) infused into the brachial artery in 23 patients with Type 2 (non-insulin-dependent) diabetes mellitus. NG monomethyl-L-arginine was employed to inhibit stimulated and basal release of nitric oxide from the endothelium. On completion of the baseline studies patients randomly received either fish oil or matching olive oil capsules in a double-blind crossover fashion for 6 weeks followed by a 6-week washout period and a final 6-week treatment phase. Studies, identical to the initial baseline studies, were performed at the end of the active treatment periods at 6 and 18 weeks. Fish oil supplementation significantly improved forearm blood flow responses to each dose of acetylcholine when compared to the vasodilator responses recorded at baseline and after olive oil administration (p < 0.01). Neither fish oil nor olive oil supplementation produced any significant changes in forearm blood flow to the incremental infusions of glyceryl trinitrate when compared with responses recorded during the baseline studies.(ABSTRACT TRUNCATED AT 250 WORDS)

The epidemiology of oral candidal carriage and infections in diabetic patients is complex and includes species which have not been previously reported in this group of patients. The development of oral candidosis in insulin-treated diabetes mellitus patients is not the result of a single entity, but rather, a combination of risk factors.

The identification of the novel candidal species, C. dubliniensis, from oral swab studies of HIV-seropositive and -seronegative individuals has led to speculation that such a species may also reside in the oral cavity of other patient groups. In this study involvement of the newly described species, C. dubliniensis, was investigated in oral carriage and disease in 414 insulin-using diabetes mellitus patients. Seventy-seven percent of the diabetic patients carried candidal species in the oral cavity. C. albicans was the most commonly identified candidal species. This was followed by C. dubliniensis, which was isolated on 64 occasions. Colonisation with multiple candidal species was common, and C. dubliniensis was present in both carriage and disease states. Seven patients without signs of oral disease had C. dubliniensis isolated as the sole candidal species, while the same species was associated with various forms of oral candidosis in six patients.

parental blood pressure has been measured. It is interesting, however, that the relation between birth weight, maternal age, and birth rank and blood pressure were largely unaffected by adjustment for reported parental history of high blood pressure and seemed to be similar in children with and without a maternal history of hypertension. These findings suggest that the means by which familial influences on blood pressure are mediated are quite separate from those of the other factors discussed. Conclusions-Diabetic drivers treated with insulin and attending clinics have no more accidents than non-diabetic subjects and may be penalised unfairly by insurance companies. IntroductionDiabetes mellitus in drivers of motor vehicles is assumed to be a potential danger both to the driver and to other road users. This belief stems from both the immediate disabling effects of hypoglycaemia and the long term implications of the disease, particularly retinopathy. With these problems diabetics might be expected to have more road traffic accidents than the general population, but available evidence is conflicting. Early studies from the United States have consistently shown higher accident rates for diabetic BMJ VOLUME 299 2 SEPTEMBER 1989 591 motorists,'"3 but Ysander's work showed reduced rates among Swedish diabetic drivers.4 We could not find a comparable controlled study in the United Kingdom, but recent evidence has suggested that insulin dependent diabetic drivers have no excess of accidents.5 We compared rates of road traffic accidents among diabetic drivers taking insulin and non-diabetic drivers. We also assessed the motoring practices of diabetic drivers and the attitudes of insurance companies towards them. Subjects and methodsA complete census of insulin dependent and noninsulin dependent diabetic patients, aged 18-65 inclusive on 1 October 1986, who had been taking insulin for at least one year was carried out at two diabetic clinics in Belfast. During an initial period of four months individual patients were recruited when they attended their respective clinic. A further eight months' follow up was required to recruit subjects who did not attend in the initial four months. Patients gave informed oral consent before participating in the survey, which had been approved by the ethical committee of Queen's University, Belfast. Each volunteer completed a confidential questionnaire under supervision by one of us.The questionnaire was divided into three sections. In the first section personal and clinical details were recorded by the supervisor. The second and third sections contained multiple choice questions and questions requiring simple yes/no answers. Some questions also required subjects to give brief written details. The second section asked for information on home monitoring of blood glucose concentration, experience of hypoglycaemia, and alcohol consumption. In the third section the current driving state of patients was established. All patients who at the time of the survey drove motor vehicles on public road...