Asian patients in Boston infrequently complain of heartburn, whereas heartburn is commonly reported by both white and black patients. Many patients do not understand the meaning of the term heartburn, however, and so physicians should be cautious when using the term during patient interviews. Complicated gastro-oesophageal reflux disease appears to be predominantly a disorder of whites.

Acute-phase serum from a patient with aplastic crisis provided sufficient human parvovirus B19 to make a monoclonal antibody against B19 and to develop antigen and immunoglobulin M (IgM) and IgG antibody detection enzyme-linked immunosorbent assays (ELISAs). The indirect capture antibody method was used for all three assays. Antigen was detected in 8 of 29 sera drawn within 2 days of onset of illness from patients with aplastic crisis. These sera had high titers of virus by electron microscopy and DNA hybridization and had no detectable B19 antibody. Antigen was not detected in serum specimens that had low titers of B19 DNA and had B19 antibody. With the IgM ELISA, we detected B19 IgM in over 85% of clinical cases of aplastic crisis and fifth disease and less than 2% of controls. The prevalence of B19 IgG antibodies increased with age. Approximately 2% of children <5 years of age and 49% of adults >20 years of age had B19 IgG antibodies. The B19 antibody ELISAs are sensitive and specific tests to detect B19 infections. Human parvovirus B19 was identified and characterized in 1975 by Cossart et al. while they were evaluating assays for hepatitis B virus in serum (11). Initially, studies to identify the clinical and epidemiological characteristics of B19 infections used counterimmunoelectrophoresis tests. Counter immunoelectrophoresis and later, a more sensitive radioimmunoassay (RIA), showed that B19 infection was associated with aplastic crisis in patients with hemolytic anemias in 1981 (31), with fifth disease in 1983 (6), with stillbirths in 1984 (8, 20), and with arthritis in 1985 (30, 33). The antibody assays require B19 antigen (P), and since B19 has not been grown in tissue culture or in laboratory animals, sera from humans remain the sole source of this antigen (7). Recently, the development of DNA hybridization assays (5, 9) has improved our ability to detect the virus, but immunoglobulin G (IgG) and IgM antibody assays remain the most sensitive way to detect B19 infection (5). An epidemiological investigation of simultaneous outbreaks of aplastic crisis and fifth disease in Ohio in the spring of 1984 (30a; T.

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Oxandrolone had a borderline significant effect in improving whole-body strength and a significant effect in improving upper-extremity strength as measured by MVICT. Given these findings, further study of this drug, possibly in combination with an immunomodulating agent, is warranted.

This study reports the clinical and sonographic outcome of arthroscopic rotator cuff repair in patients aged ≥ 70 years and aimed to determine factors associated with re-tear. A total of 69 consecutive repairs were performed in 68 patients with a mean age of 77 years (70 to 86). Constant-Murley scores were collected pre-operatively and at one year post-operatively. The integrity of the repair was assessed using ultrasound. Re-tear was detected in 20 of 62 patients (32%) assessed with ultrasound. Age at operation was significantly associated with re-tear free survival (p = 0.016). The mean pre-operative Constant score was 23 (sd 14), which increased to 58 (sd 20) at one year post-operatively (paired t-test, p < 0.001). Male gender was significantly associated with a higher score at one year (p = 0.019). We conclude that arthroscopic rotator cuff repair in patients aged ≥ 70 years is a successful procedure. The gender and age of the patient are important factors to consider when planning management.