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Posted to Co-Cure Sat, 22 Jul 2000 00:15:13 -0400 by Fred Springfield

Four Cases of Pesticide Poisoning, Presenting as “ME,” Treated with a Choline and Ascorbic Acid Mixture

Four Cases of Pesticide Poisoning, Presenting as “ME,” Treated with a Choline and Ascorbic Acid Mixture
Journal of Chronic Fatigue Syndrome, Vol. 6 No. 2, 2000, pp. 11-21
John Richardson, MB, BS

ABSTRACT.
Objectives: 1. To demonstrate in four patients, in whom the correct diagnosis of pesticide poisoning had been missed, the injustices inflicted on them when they are told ME does not exist. 2. To show how closely the features of such poisoning, especially by organochlorines, resemble those of the much more classic ME which is usually due, at least in the author’s practice in the northern region of the UK, to persistent enteroviral infection. 3. To draw attention to a new and apparently successful form of treatment with an oral mixture of choline and ascorbic acid. 4. To suggest reasons why this treatment merits further scientific investigation.

Setting: A charity based private practice involved in the investigation of viral mediated disease.

Subjects: Four patients, two male and two female, each referred with a diagnosis of ME.

Intervention: a. Samples of blood were sent to Biolab Medical Unit where a variety of pesticide residues, including the very persistent organochlorines, were identified and progress in detoxification was monitored. b. All four cases were treated orally with a choline and ascorbic acid mixture.

Results: After a variable number of months, during the early phase of which the blood levels of some of the toxins rose, possibly due to mobilization from fatty stores, all symptoms cleared as blood levels fell.

Key Messages: The term ME comprises a number of clinical features, characterizing a patient who is ill. To refuse to recognize their existence does the patient much injustice.

Some cases of ME may be found to have pesticide poisoning. The possibility of it should always be borne in mind. The source may be either in the UK or abroad. A positive enquiry and a single blood test will provide a diagnosis.

Organochlorines may persist in the body for many years, as may the symptoms derived from them.

A detoxification program based on oral administration of a choline and ascorbic acid mixture has shown much promise and deserves verification of its value.

Conclusions: Amongst the group of clinical features known as ME, the possibility of pesticide poisoning should always be borne in mind. Treatment with choline and ascorbic acid mixture is worth trying, pending its more formal investigation.

[ Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com .]

KEYWORDS. Organochlorines, pesticide poisoning, myalgic encephalomyelitis

John Richardson is affiliated with Newcastle Research Group, Belle Vue, Grange Road, Ryton, Tyne & Wear, Northumberland, NE 40 3LU, England.

The author is very grateful to H. A. Dewar, MD, FRCP, for help in the preparation of this paper, and to R. Virden, PhD, for help with some of the references.

Biolab Medical Unit wishes to make it clear that it is a medical-referral-only clinic and laboratory service and that pesticide screening is performed for medical purposes. It cannot get involved in legal claims.

Journal of Chronic Fatigue Syndrome, Vol. 6(2) 2000
© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Thu, 20 Jul 2000 22:49:42 -0400 by Fred Springfield

Measuring Outcomes of Treatment in Chronic Fatigue Syndrome: A Comparison of Simple Questioning vs. Use of a Validated Outcome Instrument (Short Form 36)

Measuring Outcomes of Treatment in Chronic Fatigue Syndrome: A Comparison of Simple Questioning vs. Use of a Validated Outcome Instrument (Short Form 36)
Journal of Chronic Fatigue Syndrome, Vol. 6, No. 2, pp. 3-11
Stanley N. Schwartz, MD, FACP, FIDSA; Rick Jones, PhD

ABSTRACT.
Purpose: To compare the outcome of treatment of chronic fatigue syndrome measured by a validated outcome instrument to patients’ perception of outcome based on simple questioning.

Subjects and Methods: Results of a single self-report question (“Are you much better, better, about the same, worse or much worse?”) at the end of approximately one year of treatment of 45 patients were compared to results of the Short Form 36 obtained at the beginning and end of that year.

Results: There was no correlation between the results of the single self-report question and the interval change in the Short Form 36 summary scales and 7 of 8 component scales.

Conclusions: Appropriate outcomes measurements can increase reliability of clinical practice results as well as treatment trials. Studies based only on answers to simple self-report questions may yield unreliable results.

KEYWORDS. Chronic fatigue syndrome, outcomes measurement, Short Form 36

INTRODUCTION

For the practicing physician caring for patients with chronic fatigue syndrome, monitoring progress and evaluating the outcome of treatment can be difficult. The absence of a consistent physical finding or laboratory test abnormality in patients with this complicated disorder presents a significant obstacle to the clinician (1,2). Many of the reported symptoms of the disorder involve a subjective component, e.g., degree of fatigue, muscle weakness, headaches, and varying kinds and degrees of pain. Reliable and valid measurement of that self-report is more important for improved treatment of chronic fatigue syndrome than for disorders where definitive physical findings or laboratory tests are available.

A simple visit-to-visit inquiry to the patient provides limited clinical data to the physician. For example, “Are you better?” or “Are you worse?” may allow the physician to compare the patient’s current well-being to the previous visit, but gives only a one-dimensional perspective and does little to measure the patient’s progress over a longer periods of time. Additionally, the reliability of such questioning to assess changes over time is impaired by the inability of patients to accurately recall health events more than a month old (2).

We have often noticed a poor correlation between a patient’s perception of improvement or decline and other life events that might serve as surrogate markers of health progress. It is not uncommon, for example, to encounter patients consistently stating they felt better yet being unable to return to work or school or carry on activities they were previously capable of accomplishing.

With this reasoning in mind, we began systematically collecting health and functioning status data on a group of patients with chronic fatigue syndrome. The measure chosen was the Short Form 36 (3,4). Because the systematic use of reliable and valid health surveys with patients in everyday clinical practice is rare, we decided to compare our Short Form 36 results with what would be the usual clinical practice, i.e., a question by the physician inquiring into the patient’s health. We hypothesized that assessing the benefit of treatment based solely on the patients’ response to a simple question about improvement or lack of improvement might not provide a reliable measure of outcome when compared to a validated outcome instrument.

We selected the Short Form 36 as our outcome instrument for several reasons. There are many other outcome measures which have been applied to chronic fatigue syndrome (5,6). However, the Short Form 36 possesses excellent psychometric credentials, reliability for both individual or group use and an ever increasing body of validity data. Additionally, it is appropriate for patients with a wide range of achieved educational levels. The Short Form 36 consists of a set of eight scales, most of which are ideally suited to tap the complex symptomatology of chronic fatigue syndrome. It measures the patient’s self-report of physical functioning, bodily pain, general health, vitality, mental health, social functioning, as well as the impact of physical and emotional factors on the individual’s ability to work and engage in daily activities. It is hard to imagine another physical or mental illness that would impact on as many of the Short Form 36 scales as does chronic fatigue syndrome. A large body of Short Form 36 normative data for persons with chronic fatigue syndrome is not available, however.

The Short Form 36 was designed as an outcome measure and is the flagship product of the Medical Outcomes Trust (Boston, MA, USA), an endowed organization devoted to making the best health outcome measures available for research and clinical assessment. The Short Form 36 is relatively easy to accomplish and can be completed in approximately 5 minutes. It may be conveniently added to a clinic visit. The institution with which one of our authors (Ri) is affiliated has the capability for in-house automated scoring as well as statistical analysis.

_________________________

[ Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com .]

_________________________

Stanley N. Schwartz is Clinical Professor of Medicine, University of Oklahoma College of Medicine-Tulsa, and also affiliated with Saint Francis Hospital and Saint Francis Health System, Tulsa, OK.

Rick Jones is Coordinator of Outcome Research, Laureate Psychiatric Clinic and Hospital, Saint Francis Health System, Tulsa, OK 74136.

Address correspondence to: Dr. S. N. Schwartz, 6565 S Yale, Tulsa, OK 74136 (E-mail: snschwartz@saintfrancis.com ).

The authors wish to thank Teresa Spencer, RMA, for assistance in collecting the self-report question data.

Journal of Chronic Fatigue Syndrome, Vol. 6(2) 2000
© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Tue, 18 Jul 2000 08:58:18 +0200 by Viveka Salomon

Increased concentrations of nerve growth factor in cerebrospinal fluid of patients with primary FMS

Increased concentrations of nerve growth factor in cerebrospinal fluid of patients with fibromyalgia.
J Rheumatol 1999 Jul;26(7):1564-9
Giovengo SL, Russell IJ, Larson AA
Department of Veterinary Pathobiology, University of Minnesota, St. Paul 55108, USA.
PMID: 10405946, UI: 99334418

This study found there was a difference in NGF (Nerve Growth Factor) levels in CSF (cerebrospinal fluid) in primary FMS, associated with other secondary conditions (SFM), patients with another painful condition but lacking FMS (OTHER) and Healthy controls.

The mean concentration of NGF measured in patients with FMS was significantly increased compared to controls but with large variability. Concentrations of NGF in SFM and OTHER were not elevated compared to controls.

The authors conclude the findings of increased concentrations of NGF in patients with FMS suggest a central mechanism and may be a factor in the pathogenesis of FMS.

Abstract

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Posted to Co-Cure Tue, 18 Jul 2000 18:45:32 +0200 by Ted Nilson

Salivary gland changes in chronic fatigue syndrome: A case-controlled preliminary histologic study

Salivary gland changes in chronic fatigue syndrome: A case-controlled preliminary histologic study.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000 Jul; 90(1):82-87 (ISSN: 1079-2104)
Woo SB; Schacterle RS; Komaroff AL; Gallagher GT
HARVARD SCHOOL OF DENTAL MEDICINE AND BRIGHAM AND WOMEN'S HOSPITAL, Assistant Professor, Dept of Oral Medicine and Diagnostic Sciences, Harvard School of Dental Medicine, Brigham and Women's Hospital., Research Assistant, Department of Internal Medicine, Brigham and Women's Hospital., Professor, Dept of Medicine, Harvard Medical School, Brigham and Women's Hospital., Associate Professor, Department of Oral Medicine and Diagnostic Sciences, Harvard School of Dental Medicine.

OBJECTIVE: The purpose of this preliminary study is to compare labial salivary gland changes of 11 patients with chronic fatigue syndrome with control subjects.Study Design: Changes in labial salivary glands were graded from 0 to 3+ for acinar dilatation, ductal dilatation, periductal fibrosis, plasmacytic infiltrate, lymphocytic infiltrate, mast cell infiltrate, and lymphocytic aggregates or foci.

RESULTS: Four of the 11 subjects had 2+ to 3+ changes in at least 4 of the 7 parameters examined. Only the presence of mast cells was statistically significant between the 2 groups. Two of these 4 patients had 1 lymphocytic focus per 4 mm(2) of tissue.

CONCLUSIONS: The salivary gland changes in patients with chronic fatigue syndrome show varying degrees of ductal and acinar dilatation, periductal fibrosis, lymphoplasmacytic infiltrates, and occasional lymphocytic foci, all suggestive of primary gland damage. The one parameter that showed statistical significance was the presence of mast cells (Fisher exact test, 0.0125).

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Posted to Co-Cure Sun, 9 Jul 2000 16:27:39 -0400

Russian article on mechanisms of CFS found in people in ecologically unfavorable conditions

[This article is dated February, 1999. It has just been indexed by MedLine and is being posted as an example of the ideas being discussed in a country seldom heard from on the subject of CFS.]

[No title available - article in Russian, and no authors given]
Journal: Klinicheskaia Laboratornaia Diagnostika (ISSN 0869-2084) 1999 Feb;(2):9-11
NLM citations: PMID: 10876679, UI: 20335411

This paper identifies two mechanisms in the development of chronic fatigue syndrome as (1) a decrease in total protein and albumin and its effective and binding capacity and (2) an increase in the content of medium molecular weight peptides; it then states these shifts were found in the blood of 206 normal subjects living in an ecologically unfavorable region and working at chemical plants but not in 24 subjects living in an ecologically safe region. No further conclusions are made in the abstract.

Abstract

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Posted to Co-Cure Sat, 8 Jul 2000 22:13:27 -0400

The search for legitimacy and the "expertization" of the lay person: the case of chronic fatigue syndrome

The search for legitimacy and the "expertization" of the lay person: the case of chronic fatigue syndrome.
Clarke JN
Sociology Department, Wilfrid Laurier University, Waterloo, Ontario, Canada.
Journal: Social Work in Health Care (ISSN 0098-1389) 2000;30(3):73-93
PMID: 10880009, UI: 20336356

This paper uses the history of chronic fatigue syndrome to examine the processes by which patients with new diseases organize to force research into and recognition of their illnesses, in the process often becoming the experts who educate their own physicians.

Abstract

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Posted to Co-Cure Sat, 8 Jul 2000 17:33:49 -0400

Odor perception: multiple chemical sensitivities, chronic fatigue syndrome, and asthma

Odor perception: multiple chemical sensitivities, chronic fatigue [syndrome], and asthma.
Caccappolo E, Kipen H, Kelly-McNeil K, Knasko S, Hamer RM, Natelson B, Fiedler N
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Environmental and Occupational Health Sciences Institute, Piscataway 08854, USA.
Journal of Occupational and Environmental Med (ISSN 1076-2752) 2000 Jun;42(6):629-38
NLM citations: PMID: 10874656, UI: 20332830

This study of 89 subjects found equivalent odor sensitivity and odor identification abilities in healthy people and in people with MCS, CFS, and asthma, although MCS subjects reported significantly more trigeminal symptoms and lower esthetic ratings for phenyl ethyl alcohol. [Trigeminal refers to the cranial nerves involved in sensory and motor functions of the face, teeth, mouth, and nasal cavity.]

Abstract

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Posted to Co-Cure Thu, 6 Jul 2000 21:00:21 -0400

Traumatic stress disorders: a classification with implications for prevention and management

Traumatic stress disorders: a classification with implications for prevention and management.
Author: Pearn J
Australian Defence Force, Royal Children's Hospital, Brisbane, Queensland, Australia.
Journal: Military Medicine (ISSN 0026-4075) 2000 Jun;165(6):434-40
NLM citations: PMID: 10870357, UI: 20328363

In this overview of stress disorders among military and peace-keeping forces, 2% - 8% of personnel are reported to develop one or more of the five acute operational stress disorders and eleven post-traumatic disorders identified by the author, with chronic fatigue syndrome grouped in the latter category.

Abstract

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Posted to Co-Cure Tue, 4 Jul 2000 13:46:07 -0400

Chronic fatigue syndrome: a matter of enzyme deficiencies?

Chronic fatigue syndrome: a matter of enzyme deficiencies?
Author: van der Steen WJ
Faculties of Biology and Philosophy, Vrije Universiteit, Amsterdam, The Netherlands.
Medical Hypotheses (ISSN 0306-9877) 2000 May;54(5):853-4
NLM citations: PMID: 10859701, UI: 20318862

The author suggests that medical literature points to "all sorts of enzyme deficiencies as causes of CFS" but that these possibilities are overlooked in error because, as with enzyme deficiency itself, not all symptoms of enzyme deficiency are found in CFS.

Abstract          Full Article

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Posted to Co-Cure Sat, 1 Jul 2000 19:00:37 +0200 by Dr. Marc-Alexander Fluks

Disturbed Neuroendocrine-Immune Interactions in CFS

Disturbed Neuroendocrine-Immune Interactions in Chronic Fatigue Syndrome
The Journal of Clinical Endocrinology & Metabolism Vol. 85, #2, p. 692-696 February 2000
Annemieke Kavelaars, Wietse Kuis, Lidewij Knook, Gerben Sinnema, and Cobi J. Heijnen
Departments of Pediatric Immunology (A.K., W.K., L.K., C.J.H.) and Psychology (G.S.), Wilhelmina Children's Hospital of the University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands

The present study was designed to investigate the interaction between neuroendocrine mediators and the immune system in chronic fatigue syndrome (CFS). We examined the sensitivity of the immune system to the glucocorticoid agonist dexamethasone and the beta- 2-adrenergic agonist terbutaline in 15 adolescent girls with CFS and 14 age- and sex-matched controls. Dexamethasone inhibits T-cell proliferation in healthy controls and in CFS patients.

However, the maximal effect of dexamethasone on T-cell proliferation is significantly reduced in CFS patients as compared with controls. The beta-2-adrenergic receptor agonist terbutaline inhibits tumor necrosis factor-alpha production and enhances interleukin-10 production by monocytes.

Our data demonstrate that the capacity of a beta-2-adrenergic agonist to regulate the production of these two cytokines is also reduced in CFS patients. We did not observe differences in baseline or CRH-induced cortisol and ACTH between CFS patients and controls. Baseline noradrenaline was similar in CFS and controls, whereas baseline adrenaline levels were significantly higher in CFS patients.

We conclude that CFS is accompanied by a relative resistance of the immune system to regulation by the neuroendocrine system. Based on these data, we suggest CFS should be viewed as a disease of deficient neuroendocrine-immune communication.

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Posted to Co-Cure Fri, 16 Jun 2000 17:09:46 -0400

Chronic fatigue syndrome: gender differences in the search for legitimacy

Chronic fatigue syndrome: gender differences in the search for legitimacy.
Author: Clarke JN
Affiliation: Department of Sociology and Anthropology, Wilfrid Laurier University, Waterloo, Ontario, Canada.
Australian and New Zealand Journal of Mental Health Nursing [ISSN: 1324-3780] 1999 Dec;8(4):123-33
NLM citations: PMID: 10855087, UI: 20313138

Data were collected from 59 respondents (18 male, 41 female) in telephone interviews. While respondents explained the causes of the disease in ways that were largely gender appropriate, they did not experience the disease itself in gender different ways. This evidence points to a clear dichotomy between (a) the ways in which men and women experience the disease and (b) differences in the ways in which they are treated by the medical profession.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10855087&dopt=Abstract

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Posted to Co-Cure Fri, 16 Jun 2000 17:00:27 -0400

Significant other responses are associated with fatigue and functional status among patients with CFS

Significant other responses are associated with fatigue and functional status among patients with chronic fatigue syndrome.
Authors: Schmaling KB, Smith WR, Buchwald DS
Affiliation: University of Washington, Seattle 98195-6560, USA. & nbsp E-Mail: karens@u.washington.edu
Journal: Psychosomatic Medicine [ISSN 0033-3174] 2000 May-Jun;62(3): 444-50
NLM citations: PMID: 10845358, UI: 20301968

The authors studied 119 CFS patients living with a significant other [SO] to examine relationship satisfaction, responses of the SO to fatigue symptoms, and outcome measures of fatigue and functional status. Results indicated that solicitous SO responses to CFS-related symptoms are associated with poorer patient outcomes, especially in the context of a satisfactory intimate relationship. The authors conclude that further research is need to determine whether these results are a product of sicker patients needing more care, or whether helpful, positive SO responses may be inadvertently positively reinforcing illness-related behavior.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10845358&dopt=Abstract

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Posted to Co-Cure Wed, 14 Jun 2000 15:51:56 -0400 by Fred Springfield

Symptom patterns in long-duration chronic fatigue syndrome

Symptom patterns in long-duration chronic fatigue syndrome.
J Psychosom Res 2000 Jan;48(1):59-68
Friedberg F, Dechene L, McKenzie MJ 2nd, Fontanetta R
Department of Mathematics, Fitchburg State College, MA, USA.
PMID: 10750631, UI: 20212669

OBJECTIVE: Our objective was to evaluate symptom patterns in patients with chronic fatigue syndrome (CFS) who were ill for 10 or more years.

METHODS: This cross-sectional self-report study compared patient groups with long-duration (median = 18 years; n = 258) and short-duration (median = 3 years; n = 28) CFS to a group of healthy significant others (n = 79) on symptomatic, neurocognitive, and psychological variables. Data were gathered from a 574-item postal questionnaire.

RESULTS: A principal-components analysis of CFS symptom data yielded a three-factor solution: cognitive problems; flu-like symptoms; and neurologic symptoms. Compared with the short-duration CFS group, the long-duration group had significantly higher CFS symptom severity scores (p < 0.04), largely attributable to increased cognitive difficulties. A subgroup comparison of subjects ill for < 3 years versus those ill 4-7 years suggested that denial coping strategies were more likely in those participants with the shorter illness duration. Significant differences between both CFS groups and healthy controls were found in a number of comorbid disorders. Participants with CFS most often endorsed immune/viral abnormalities and persistent stress as important perceived causes of their illness.

CONCLUSION: Participants with long-duration CFS reported a large number of specific cognitive difficulties that were greater in severity than those reported by participants with short-duration CFS. The pattern of comorbid disorders in the CFS groups was consistent with hypersensitivity and viral reactivation hypotheses.

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Posted to Co-Cure Tue, 13 Jun 2000 23:04:16 -0400

Scientists Discover Migraines Are A Unique Brain Disorder

[Migraines are often associated with CFS and FMS.]

June 13, 2000 WASHINGTON (AP) - The pain of a migraine can be so intense it's disabling. Your head pulses, usually on one side, for hours or even days. Moving worsens the throbbing. You're nauseated, sensitive to light and sound. Sometimes you have an "aura," seeing pinpoints of light or other visual disturbances before the headache hits.

Many of those who suffer this pain don't realize that migraines - and not some other headache - are to blame, and millions go without treatment.

That's particularly disturbing to experts because, in a revolutionary shift, scientists are discovering that migraines are caused not by the abnormal blood vessels once blamed but by a unique electrical disorder of brain cells.

Read the full article at: http://ipn.intelihealth.com/IPN/ihtIPN?st=23883&t=7223&c=285897

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Posted to Co-Cure Wed, 7 Jun 2000 22:05:34 -0400

Cryotherapy for pain relief

[Cryotherapy for pain relief] [No title available from MedLine - Article in German]
Authors: Metzger D, Zwingmann C, Protz W, Jackel WH
Affiliation: Hochrhein-Institut fur Rehabilitationsforschung, Department fur Epidemiologie und Sozialmedizin, Bad Sackingen.
Rehabilitation (Stuttg) [ISSN 0034-3536] 2000 Apr;39(2):93-100
NLM citations: PMID: 10832164, UI: 20291627

120 pain patients (including 40.7% with primary FMS and 3.6% with secondary FMS) were treated with cryotherapy for 2.5 minutes on average in the main cryotherapy chamber (mean temperature: -105 degrees C [= -157 degrees F]). Pain level after therapy decreased significantly, with the reduction lasting about 90 minutes, and initial pain level decreased during the whole time of treatment. However, no significant improvement could be shown from the middle to the end of the four-week treatment. The authors concluded that whole-body cold therapy generated important short-term effects and somewhat weaker effects over the treatment period as a whole.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10832164&dopt=Abstract

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Note: All abstract summaries, unless otherwise noted, were prepared by Margaret Bailey.


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