2097 LETTERS tation (2). Identification of some of the autoantigens was made possible with these further studies. It is of interest to address another issue raised by Nishikai and Kosaka. When they used HEp-2 cells produced by one company (Medical and Biological Laboratories), they did not observe any nuclear envelope staining in the CFS patients. In contrast, when they used HEp-2 cells from another company (Kdllestad), nuclear envelope staining was demonstrated in patients with RA. It is curious that they d o not mention whether CFS patients demonstrated nuclear envelope staining with this latter substrate. Notwithstanding this omission, it might be important to point out, as noted by Nishikai and Kosaka, that different HEp-2 cell substrates from different companies appear to behave differently. The precise factors causing this variation havc not bcen determined, but one of these factors could be related to different methods used for “fixation” of the substrate. This is usually proprietary information that is difficult to obtain from the manufacturers, but our personal experience with the use of different fixatives shows that the reactivity of certain autoantigens can be destroyed by some fixation methods and not by others. Nishikai and Kosaka agree with our observation that CFS patients have intermediate ANA titers compared with patients with lupus and certain other autoimmune diseases. They point out, however, that the greatest difference between their results and ours involves the frequency of positive immunofluorescent ANA in the 2 studies. This may be related merely to the sensitivity and specificity scales used in differcnt laboratories. They report that 6% of their healthy subjects were ANA positive. In a large multicenter study performed by an ANA Standardization Committee of the International Union of Immunological Societies, it was shown that in a sample of 120 healthy individuals, 32% were ANA positive at a 1:40 dilution of serum, 12% were positive at 1 3 0 , and 5% were positive at 1:160 (3). Thus, the figure of 6% ANA positivity at a 1:40 serum dilution in healthy individuals studied by Nishikai and Kosaka is quite different from the finding in this multicenter study and may explain the low percentage of positive results at this dilution among the CFS patients in their study. E. M. Tan, M D A. von Mikecz, PhD K. Konstantinov, M D L. Gerace, PhD The Scripps Research Institute L a Jolla, CA D. S. Buchwald, M D University of Washington School of Medicine Seattle, WA 1. Von Mikecz A, Konstantinov K, Buchwald DS, Gerace L, Tan EM: High frequency of autoantibodies to insoluble cellular antigens in patients with chronic fatigue syndrome. Arthritis Rheum 40:205305. 1997 2. Konstantinov K, von Mikecz A, Buchwald D, Jones J, Gerace L, Tan EM: Autoantibodies to nuclear envelope antigens in chronic fatigue syndrome. J Clin Invest 98:1888-1896, 1996 3. Tan EM, Feltkamp TEW, Smolen JS, Butcher B, Dawkins R, Fritzler MJ, Gordon T, Hardin JA, Kalden JR, Lahita RG, Maini RN, McDougal JS, Rothfield NF, Smeenk RJ, Takasaki Y, Wiik A, Wilson MR, Koziol J A Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum 40:1601-1611, 1997 Uncompensated cervical traction as a possible cause of symptoms in women with breast implants: comment on the article by Buskila et a1 To the Editor: I read with interest the article by Buskila et a1 relating generalized fibromyalgia to biomechanical disturbances of the neck (Buskila D, Neumann L, Vaisberg G, Alkalay D, Wolfe F: Increased rates of fibromyalgia following cervical spine injury: a controlled study of 161 cases of traumatic injury. Arthritis Rheum 40:446-452, 1997). The findings are in keeping with observations on patients with breast implants whose major defined disease process appears to be fibromyalgia. Women with breast implants who have never developed the necessary accessory muscles to support average amounts of breast tissue or who have had these muscles cut during mastectomies suddenly find themselves with 1 or 2 pounds of breast implant, along with its contracting scars, generating traction on the cervical and paracervical musculature. In light of the findings of Buskila et a1 and of others (Bennett RM, Smythe HA, Wolfe F: Recognizing fibromyalgia. Patient Care 23:60-83, 1989), it is not surprising that years of uncompensated cervical stress on the neck, upper chest, and upper back would eventuate in fibromyalgia. In our attempt to elucidate the mechanisms of distress in patients with breast implants, we may have overlooked the most obvious, a chronic mechanical traction on the cervical spine and its musculature. Hugh McGrath, Jr., M D Louisiana State University New Orleans, LA Passing of an American College of Rheumatology collaborator and friend To the Editor: We wish to bring to the attention of the American College of Rheumatology and the Arthritis Foundation the news of the recent death of Lester Bergman. Lester and his wife Sylvia, who died a few years ago, were guiding and nurturing forces in the development of the American College of Rheumatology (ACR) Clinical Slide Collection on the Rheumatic Diseases. They helped create the Arthritis Foundation Pathology Collection, which was the forerunner of the Clinical Slide Collection, and thereafter, with great expertise and congeniality, brought to fruition the educational goals of the many rheumatologists who served on the Audiovisual Aids Subcommittee as the original Collection, and its later editions, were produced. The Bergmans ensured that the Collection would be of the highest integrity and best quality. The Bergmans werc far more than just film processorsthey were world-class artists whose medium was photographic film. To faithfully reproduce the subtle “salmon pink” of the juvenile rheumatoid arthritis rash or suggest the 3-dimensionality of palpable purpura was not a problem; it was a challenge for LETTERS which they were game. In a soft and educated voice, Lester would look at a submitted slide, study the color in various lights, control for the projection bulb and screen. on occasion even ask to see the patient, and then conclude with something like ‘.I’ll add a little magenta, and it will work.” More often than not, it did work, and if not to our satisfaction, they repeated the process until we clinicians said it looked right. They were very particular, too: on more than one occasion they brought to our attention an error (some medical!) that we had overlooked. The Bergmans’ artistry transcended color. Thcy could hide an unwanted reflection, clean a background, lighten a shadow, and re-position or crop until a desired but ugly slide became a work of art and an effective educational tool. They were welcoming and friendly people, on occasion inviting us to their home and studio in Cold Spring, NY. After proudly exhibiting their archaeological artifacts and botanical specimens (two of their many other interests), they then patiently explained their production and preservation processes to us. Original slides and other submitted materials will last many generations because of their care and concern. Lester and Sylvia Bergman were passionate craftspeople of an old school that barely survives today. The usefulness and quality of the ACR Clinical Slide Collection are thcir Icgacy. It was a pleasure for us to have known and worked with them. Leon Sokoloff, M D Stony Brook, N Y E. Canvile LeRoy, M D Charleston, SC Michael D. Lockshin, M D New York, NY Joseph D. Croft, Jr., M D Chevy Chase, M D Sidney R. Block, M D Bangor, ME William W. Ginsburg, M D .la cksonville, FL Michael J. Maricic, M D Tucson, A Z Past Chairs, A C R Audiovisual Aids Suhconimittee Eric L. Matteson, M D Rochester, MN Ciiwent Chair, A C R Audiovisual A i h Subcommittee Jane Diamond, M P H Atlanta, G A Managing Editor, A C R Clinical Slide Collectiorz on the Rheumatic Diseases STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION (Act of August 12, 1970: Section 3685, Title 39 United States Code) Date of Filing-October 1,1997. Title of Publication-Arthritis & Rheumatism; Frequency of Issue-Monthly; Annual Subscription Price-$150.00; Location of Known Office of Publication-12107 Insurance Way, Suite 114, Hagerstown, MD 21740; Location of Headquarters of General Business Offices of the Publisher-Lippincott-Raven Publishers, 227 Eact Washington Square, Philadelphia, PA 19106: Publisher-Lippincott-Raven Publishers, 227 East Washington Square, Philadelphia, PA 19106; Editor-William P. Arend, MD, University of Colorado Health Sciences Center, Box B-l17,4200 E. 9th Avenue, Denver, CO 80262; Managing Editor-Jane S. Diamond, MPH, American College of Rheumatology, 60 Executive Park South, Suite 150, Atlanta, GA 30329; Owner-American College of Rheumatology, 60 Executive Park South, Suite 150, Atlanta, GA 30329; Known Bondholders, Mortgagees, and other security holders owning or holding 1 percent or more of total amount of bonds, mortgages, or other securities-none. A. Total no. copies printed (net press nin),average 10,400, actual 10,600; B. Paid circulation 1. Sales through dealers and carriers, street vendors and counter sales, average none, actual nonc; 2. Mail subscriptions, average 8,988, actual 8,965; C. Total paid circulation, average 8,988, actual 8,965; D. Free distribution by mail, carrier or other means. Samples complimentary, and other free copies, average 188, actual 138; E. Total distribution (sum ofC and D ) , average 9,176, actual 9,103; F. Copies not distributed 1. Office use, leftover, unaccounted, spoiled after printing, average 1,224, actual 1,497. Returns from news agents, none; G. Total (sum of E (e F-should equal nefpress nin shown in A ) , average 10,400, actual 10,600. I certify that the statements made by me above are correct and complete. Beverly V. Dietrich, Circulation Director.