TO THE EDITOR:
I was surprised that, in the article "Gastrointestinal Problems in Patients Who Have Type-III Osteogenesis Imperfecta" (77-A: 1352—1356, Sept. 1995), Lee et al. did not mention the very important problem of excessive sweating by children who have osteogenesis imperfecta. It is well known that many children who have this condition have a severe insensible loss of fluid, and secondary constipation is a frequent problem. This was first pointed out to me by Dr. Gene Bleck, who is from the authors' home institution in Stanford. I am not questioning the authors' findings that pelvic deformity may add to the problem; however, I think that the problem of insensible loss of fluid secondary to sweating should have been included in the discussion.
Robert N. Hensinger, M.D.: Orthopaedic Surgery, The University of Michigan, Second Level Taubman Center, University Hospitals, Box 0328, Ann Arbor, Michigan 48109-0328
Dr. Lee, Dr. Gamble, Dr. Moore, and Dr. Rinsky reply:
Dr. Hensinger mentions the well known subjective impression that children who have osteogenesis imperfecta sweat excessively, and he brings up the potential role of insensible loss of fluid as a cause of chronic constipation and abdominal pain in these patients. In our experience, some parents of patients who have osteogenesis imperfecta have reported that their child seems to sweat excessively, and these patients commonly do seem to be febrile during the operation and in the postoperative period. However, we are unaware of any studies documenting an increased insensible loss of fluid on a daily basis or increased postoperative measurements of temperature compared with that of age and gender-matched controls, although this is an interesting area for further investigation. We do not think that increased insensible loss of fluid or increased basal body temperature can account for the findings in our study. By comparing two subgroups of patients who had type-III osteogenesis imperfecta, those who did and those who did not have abdominal pain, we had an internal control for variables that are difficult to measure, such as insensible loss of fluid. The results of our study indicate that chronic constipation and abdominal pain are strongly associated with severe acetabular protrusion in patients who had type-III osteogenesis imperfecta.
John H. Lee, M.D.; James G. Gamble, M.D., Ph.D.; Lawrence A. Rinsky, M.D.: Division of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Building R-144, Palo Alto, California 94304
Ralph E. Moore, M.D.: Division of Orthopaedic Surgery, Bowman Gray University School of Medicine, 300 South Hawthorne Road, Winston-Salem, North Carolina 27103