Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis.

Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularization in various tissues. The purpose of this study was to investigate whether CEUS could be used to visualize the microvascular volume (MV) in the plantar fascia, and to compare the method to clinical symptoms and B-mode ultrasound (US) in patients with plantar fasciitis (PF). Twenty patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5), and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients, a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter-observer correlation as well as intra-observer agreement was excellent. The MV in the plantar fascia and plantar fat pad can be measured reliably using CEUS, suggesting that it is a reproducible method to examine patients with plantar fasciitis.

Achilles tendinopathy: A prospective study on the effect of active rehabilitation and steroid injections in a clinical setting.

In published efficacy studies on Achilles tendinopathy (AT) exercise alone results in improvement in 60-90% of the cases. However, this high success rate cannot be expected in usual clinical practice. We prospectively investigated the effectiveness of a treatment regimen consisting of home-based exercises (concentric, eccentric, and stretching) and optional glucocorticosteroid (GCS) injections in patients with (AT) in a usual clinical setting. Patients unable to commence or progress in exercise were offered GCS, hypothesizing that the GCS would facilitate exercise. Ninety-three consecutive patients with AT referred to two outpatient rheumatology clinics were registered, and seen at five visits over a 6-month period. Exercises seemed to have a slow, but long-lasting effect with GCS having a dramatic short-term effect on symptoms. Twenty-six percent of the patients could proceed with training alone, the remainder received one to three supplementary GCS. There were significant improvements on all outcome variables over time (P ≤ 0.001). At follow-up, 42 had no more symptoms, 29 good result, 16 slightly improved, 4 unchanged, and 2 slightly worse. Overall, 94% of the patients had improved, and we thus recommend the use of GCS injections in AT patients if training alone does not lead to improvement.

Mutagenicity assessment of acrylate and methacrylate compounds and implications for regulatory toxicology requirements.

Esters of acrylic acid and methacrylic acid, more commonly known as acrylates and methacrylates, respectively, are key raw materials in the coatings and printing industry, with several of its chemical class used in food packaging. The results of over 200 short-term in vitro and in vivo mutagenicity studies available in the open literature have been evaluated. Despite differences in acrylate or methacrylate functionality or in the number of functional groups, a consistent pattern of test response was seen in a typical regulatory battery of mutagenicity tests. No evidence of point mutations was observed when acrylic acid or over 60 acrylates and methacrylates were investigated in Salmonella bacterial tests or in hprt mutation tests mammalian cells, and no evidence of a mutagenic effect was seen when tested in whole animal clastogenicity and/or aneuploidy (chromosomal aberration/micronucleus) studies. Consistent with the in vivo testing results, acrylic acid exhibited no evidence of carcinogenicity in chronic rodent cancer bioassays. In contrast, acrylic acid and the entire acrylate and methacrylate chemical class produced a consistently positive response when tested in the mouse lymphoma assay and/or other in vitro mammalian cell assays designed to detect clastogenicity. The biological relevance of this in vitro response is questioned based on the non-concordance of in vitro results with those of in vivo studies addressing the same mutagenic endpoint (clastogenicity). Thus, in short-term mutagenicity tests, the acrylates and methacrylates behave as a single chemical category, and genotoxicity behavior of a similar chemical can be predicted with confidence by inclusion within this chemical class, thus avoiding unnecessary testing.

Toxicological profile of carboxymethyl inulin.

Carboxymethylinulin (CMI), formed by carboxylation of a natural carbohydrate obtained from the chicory plant, is particularly effective in sequestration of hard water cations, and thus serves as a unique anti-scalant which could find uses in food processing. A series of toxicological studies has been performed to investigate its toxiciologic properties following repeated exposure, possible sensitization, and its potential to elicit genotoxic activity; all studies conformed to internationally accepted safety test guidelines currently in force. Subacute (4-week) oral toxicity was investigated in groups of rats exposed via gavage to 0, 50, 150 and 1000 mg/kg/day CMI. No treatment-related effects were observed in body weight, food consumption, mortality, hematology, clinical blood chemistry, organ weights or gross or microscopic pathology up to the highest dose (1000 mg/kg/day) tested. Motor activity, as observed in a functional observation battery, was elevated in high-dose females, and is not considered of significance toxicologically. Lack of adverse toxicity seen with CMI at this dosage is consistent with a similar lack of significant toxicity exhibited by other dietary carbohydrates (sorbitol, sucrose, glucose), oligofructoses (inulin/FOS) and carboxylated cellulose in repeated-dose rat studies at approximately the same dosage. No evidence of dermal sensitization was observed in groups of guinea pigs following CMI testing by the Magnusson-Kligman maximization test methodology. No mutagenic activity was observed when CMI was tested in four Salmonella strains-TA1535, TA1537, TA98 and TA100-or in Escherichia coli WP2uvrA bacterial point mutation assays or in an in vitro Chinese hamster ovary cell chromosomal aberration assay. The results obtained in the present study with CMI are consistent with similar data derived on numerous dietary carbohydrate fibers generally recognized as safe in the human diet.

Ultrasound therapy in chronic leg ulceration: a meta-analysis.

We reviewed all articles on ultrasound therapy published since 1950 to assess the evidence for an effect of this therapy in the treatment of chronic leg ulcers. Fourteen studies concerning ultrasound therapy, chronic leg ulcers, and wound healing were found. The six studies that fulfilled inclusion criteria for a randomized controlled trial were generally found lacking with respect to description of ulcer etiology-treated area, ultrasound head area, control of ultrasound apparatus, sham ultrasound apparatus, and follow-up evaluations. However, all six studies presented their data in a way that made pooling possible with respect to a decrease in ulcer area as a percent of the starting area. A standardized effect size was applied and gave evidence for a significant effect of ultrasound, showing a 16.9% (CI95: 6.3% to 27.5%, p = 0.011) mean difference in healing after 4 weeks of treatment and a 14.5% (CI95: 6.6% to 22.3%, p = 0.005) mean difference after 8 weeks of treatment compared with control treatment. In three studies, the number of healed ulcers was assessed, and pooling showed a nonsignificant (p = 0.06) therapeutic gain of 15% (CI95: 1% to 30%). This analysis would suggest that ultrasound has the best effect being delivered in low doses around the edge of the ulcer, but further studies are required to confirm this possible effect and to evaluate a possible dose-response relationship.

Determinants of musculoskeletal flexibility: viscoelastic properties, cross-sectional area, EMG and stretch tolerance.

Cross-sectional area, stiffness, viscoelastic stress relaxation, stretch tolerance and EMG activity of the human hamstring muscle group were examined in endurance-trained athletes with varying flexibility. Subjects were defined as tight (n = 10) or normal (n = 8) based on a clinical toe-touch test. Cross-sectional area was computed from magnetic resonance imagining (MRI) images. Torque (Nm) offered by the hamstring muscle group, electromyographic (EMG) activity, knee joint angle and velocity were continuously monitored during two standardized stretch protocols. Protocol 1 consisted of a slow stretch at 0.087 rad/s (dynamic phase) to a pre-determined final angle followed by a 90-s static phase. In the dynamic phase final angle and stiffness was lower in tight (28.0+/-2.9 Nm/rad) than normal subjects (54.9+/-6.5 Nm/rad), P<0.01. In the static phase tight subjects had lower peak (15.4+/-1.8 Nm) and final torque (10.8+/-1.6 Nm) than normal subjects (31.6+/-4.1 Nm, 24.1+/-3.7 Nm, respectively)(P<0.01), but torque decline was similar. Protocol 2 consisted of a slow stretch to the point of pain and here tight subjects reached a lower maximal angle, torque, stiffness and energy than normal subjects (P<0.01). On the other hand, stiffness was greater in tight subjects in the common range (P<0.01). Cross-sectional area of the hamstring muscles and EMG activity during the stretch did not differ between the groups. However, lateral hamstring cross-sectional area was positively related to mid-range stiffness (P<0.05), but inversely related to final stiffness, peak torque and the toe-touch test (P<0.01). Final angle and peak torque in protocol 1 combined to improve the predictability of the toe-touch test (R2=0.77, P<0.001). These data show that the toe-touch test is largely a measure of hamstring flexibility. Further, subjects with a restricted joint range of movement on a clinical toe-touch test have stiffer hamstring muscles and a lower stretch tolerance.

The treatment of acute soft tissue trauma in Danish emergency rooms.

Rest, ice, compression, elevation (RICE) is the most recommended treatment for acute traumatic soft tissue injuries. A questionnaire was given to all Danish emergency rooms (n = 5) regarding their routines for acute treatment of ankle sprains and muscle contusions. Complete answers were received from 37 emergency rooms (73%), covering the treatment of 111 ankle sprains and 101 muscle contusions. Treatment with RICE was given in a minority of injuries, ice (21%), compression (32%) and elevation (58%) similarly between injury types. A complete RICE treatment was rarely applied (3%). Verbal information on RICE and rehabilitation was given in less than half of the cases. We conclude that the acute treatment of ankle sprains and muscle contusions in the Danish emergency rooms is not applied in accordance with consensus from international literature, and that the instruction in rehabilitation should be improved.

Mixture risk assessment: a case study of Monsanto experiences.

Monsanto employs several pragmatic approaches for evaluating the toxicity of mixtures. These approaches are similar to those recommended by many national and international agencies. When conducting hazard and risk assessments, priority is always given to using data collected directly on the mixture of concern. To provide an example of the first tier of evaluation, actual data on acute respiratory irritation studies on mixtures were evaluated to determine whether the principle of additivity was applicable to the mixture evaluated. If actual data on the mixture are unavailable, extrapolation across similar mixtures is considered. Because many formulations are quite similar in composition, the toxicity data from one mixture can be extended to a closely related mixture in a scientifically justifiable manner. An example of a family of products where such extrapolations have been made is presented to exemplify this second approach. Lastly, if data on similar mixtures are unavailable, data on component fractions are used to predict the toxicity of the mixture. In this third approach, process knowledge and scientific judgement are used to determine how the known toxicological properties of the individual fractions affect toxicity of the mixture. Three examples of plant effluents where toxicological data on fractions were used to predict the toxicity of the mixture are discussed. The results of the analysis are used to discuss the predictive value of each of the above mentioned toxicological approaches for evaluating chemical mixtures.

Exercises for chronic low back pain: a clinical trial.

Different training models are effective for the treatment of chronic low back pain, but no consensus has been found. Earlier studies have emphasized training of spinal mobility and back strength. To evaluate if other physiological parameters, such as coordination, are of equal importance, we performed a randomized trial on 40 consecutive patients with chronic low back pain. Two training models were compared: 1) intensive training of muscle endurance and 2) muscle training, including coordination. In both groups, training was performed 1 hour twice a week for 3 months. Pain score, disability score, and spinal mobility improved in both training groups without differences between the two groups. Only intensive training of muscle endurance improved isokinetic back muscle strength. At study entry, we found a significant correlation between spinal mobility and dysfunction, but after the training, no correlation was found between improvement of spinal mobility or isokinetic back extension strength and improvement of function or pain level. We conclude that coordination training for patients with chronic low back pain is as equally effective as endurance training.

[Alternative treatment of athletic injuries]. / Alternativ behandling af idraetsskader.

A questionnaire was carried out in a Danish sports clinic to find out how many sports-injured patients seek alternative medical treatment. One hundred and fifty persons (81%) answered the questionnaire. Forty-seven percent of the women and 35% of the men had at some time tried alternative medicine. These high numbers might be explained by dissatisfaction with the official medical treatment of sports injuries in Denmark. No age or income difference was found between the persons who had tried alternative medicine compared to the patients who had never tried it. Fifty-nine percent of those who had sought alternative medicine did not find it effective. There is a need for clinically controlled trials to find out if some alternative medical treatments do have effects on some specified injuries.

Supervised endurance exercise training compared to home training after first lumbar diskectomy: a clinical trial.

OBJECTIVE: We performed a randomised trial to evaluate if intensive supervised training of the back should be offered to all patients after a first lumbar diskectomy. METHODS: Forty consecutive patients were, after a first lumbar diskectomy, randomly allocated to 2 groups undergoing "supervised training" twice a week for 3 months in an outpatient clinic or "home training" after 2 hours of instruction. RESULTS: The two rehabilitation models both showed a significant effect on spinal mobility, isokinetic trunk flexion strength, isokinetic trunk extension strength and daily function. These improvements were unchanged at follow up 3 months later. The pain score remained unchanged, however, throughout the trial in both groups. No differences in effect between the two rehabilitation models could be found for any of the assessed parameters. Thirteen patients did not complete the trial, including 9 from the supervised endurance trained group, mainly because of increased pain and reprolaps (n = 4). Four patients dropped out of the home trained group, only one because of increased pain. The differences in drop-out rate and training side effects were, however, not statistically significant. CONCLUSION: We conclude that it is not worthwhile to implement 3 months of supervised intensive endurance training as opposed to home training in all cases of first lumbar diskectomy, although a beneficial effect and better compliance might be found for a selected group of such patients.

Low energy laser therapy in rheumatoid arthritis.

Low energy laser (LEL) is a widely used treatment for a variety of musculoskeletal disorders although convincing documentation of the effect is missing. We have examined the LEL effect on Rheumatoid Arthritis (RA) in a double blind placebo controlled study. Twenty-two patients completed the study (10 receiving LEL treatment) according to the protocol. A significant effect on pain score was found due to LEL treatment, but when data were corrected for disease variation the effect disappeared. No effect of LEL could be demonstrated on the other assessed variables: grip strength, morning stiffness, flexibility, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). In conclusion, we did not find that LEL had any clinically relevant effects on RA.

Rebox: an adjunct in physical medicine?

Electrical therapy is used extensively in the treatment of musculoskeletal diseases. The best known form is transcutaneous electrical nerve stimulation (TENS). Rebox is another apparatus for electrical therapy that operates on much lower currents than TENS (0 to 300 microA). The effect of Rebox was tested on chronic lateral epicondylitis in 16 patients in a controlled crossover study. We found a significant effect of Rebox compared to placebo in respect to all the subjective and the objective variables: grip-strength, pain at power-grip and lifting a weightload with pronated forearm, and daily impairment.

Liquid chromatographic method for separation and determination of elaiophylin in biotechnology processes of salinomycin production.

An LC method for the quick and precise quantitative determination of elaiophylin in biotechnology processes of salinomycin production was prepared. A mobile phase of methanol 0.04 M diammonium hydrogen phosphate pH 6.0-ethyl acetate (55:35:10, v/v/v) and an elevated column temperature optimized the chromatography. Separation of elaiophylin was obtained in 4-6 min. Positive identification and peak purity of elaiophylin have been carried out by photodiode array (PDA) detection. An agreement between the PDA spectra of samples and the elaiophylin standard were obtained.

Microbiological assay of avoparcin in animal feeds and pre-mixes--co-operative study.

A microbiological method for the determination of the antibiotic growth promoter avoparcin in animal feeds and pre-mixes was first published in 1979. The existing method has been applied to new matrices as commercial use of avoparcin has spread. Problems with the existing analytical procedure have been reported, particularly in Germany. This paper identifies the causes of the problems and includes revisions to the existing analytical procedure. The testing of these revisions in co-operative studies with up to five German official laboratories is also reported.

Toxicity of calcium sodium metaphosphate fiber. II. Chronic inhalation and oncogenicity study.

Male and female Fischer 344 rats (80/sex/group) were exposed to CSM fiber 6 hr/day, 5 days/week at target-exposure levels of 0, 1, 5, or 25 mg/m3 for 24 months, corresponding to 0, 27, 80, and 513 fibers/cc, respectively. Number and size of the airborne fibers were determined during the course of the study. At 3 and 12 months, 10 rats/sex/group were euthanized and at 18 and 24 months 5 rats/sex/group were euthanized. In addition, 5 rats/sex/group were removed from exposure at 18 months and maintained for a 6-month recovery period. All animals surviving at the completion of the exposure period were maintained in a clean environment for up to 5 additional months. Clinical laboratory examinations were performed on 10 animals/sex/group at 3, 12, and 24 months. The number of fibers in the lung were also determined at 3, 12, 18, and 24 months. Body weight and survival did not appear to be affected by treatment. There were no biologically significant effects on clinical parameters. There was a dose-related increase in lung weight during the exposure period which was generally reversible during the recovery periods. There also was a dose-related increase in the number of fibers/milligram of lung, but no increase in lung fiber burden after the first 3 months. The number of fibers in the lungs of animals exposed to CSM fiber for 18 months and allowed 6-month recovery period showed a decrease especially at the high dose. No increase in tumors (benign or malignant) was observed in this study. Microscopic changes considered reflective of an irritant response were observed in the nasal turbinates notably at the 5 and 25 mg/m3 levels. Histological changes were also observed in the lungs at the 5 and 25 mg/m3 levels. The incidence and/or severity of histopathological changes in the 1 mg/m3 group was considered to be essentially comparable to controls.

Evaluation of teratogenic potential of N-formylpiperidine in rats.

The teratogenic potential of a versatile solvent, N-formylpiperidine (NFP), was evaluated in the rat. Three groups of 25 mated female Sprague-Dawley rats were given 110, 220, or 440 mg/kg/day NFP in distilled water by gavage on Days 6 through 20 of gestation. A control group of 25 animals received distilled water on a comparable regimen. Maternal animals were observed daily for signs of toxicity; body weights and food consumption were measured at regular intervals throughout the study. All animals were euthanized on Gestation Day 21 and the fetuses examined for cleft palate and external abnormalities. One-half of the fetuses in each litter were examined for visceral anomalies while the remaining fetuses were examined for skeletal malformations after appropriate staining. One female in the high dosage group died on Gestation Day 12. Clinical signs of toxicity, observed in 6 females in the high dosage group, included tremors, convulsive movements, and an apparent weakness of the legs. Maternal toxicity, in terms of significantly decreased body weight and food consumption, was observed in the mid and high dosage groups. Food consumption was also significantly depressed for the first 4 days of dosing in the low dosage group. There was a significant increase in number of resorptions in the high dosage group when compared to controls. No effects were observed on other reproductive parameters. Mean fetal body weight was significantly lower in the high dosage group when compared to controls. While the incidence of fetal malformations on a litter basis was higher in the high dosage group, this change was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[The whiplash injury. An overlooked and casually treated syndrome]. / Piskeslagslaesion. Et overset og tilfaeldigt behandlet syndrom.

The whiplash trauma is defined as hyperextension followed by hyperflexion of the cervical spine or the reverse. The lesion occurs mainly in the occupants of a motor vehicle into which another vehicle collides from behind. Even when there is no radiographic evidence of injury, considerable lesions of the soft tissues may, nevertheless, be present. Review of the literature and the present authors' investigations reveal that up to 80% of the patients have chronic symptoms and 10% of these are severe enough to cause incapacity. The therapeutic regimen has not been well investigated but, at present, intermittent cooling and support by a collar for a few days followed by rapid mobilizing and exercises within the limit of pain are recommended.

Hepatic involvement of two chlorinated propenes following repeated oral exposure in the rat.

The comparative toxicity of two chlorinated propene isomers, 1,2,3-trichloropropene (TRCP) and 1,1,2,3-tetrachloropropene (TECP), was investigated via subchronic oral administration to rats for 4 weeks. Test groups, each consisting of 5 male and 5 female rats, were exposed to 0, 3, 10, 30, 100 or 300 mg/kg/d TRCP or TECP by gavage. A separate corn oil control group was used for each chloropropene. While all rats of both sexes given 300 mg/kg/d TRCP died, only 1 female exposed to 300 mg/kg TECP died. Mean body weights were reduced in male rats given 100 mg/kg/d TRCP. With TECP, dose-related reductions in mean body weight and food consumption were seen at 100 and 300 mg/kg/d. Moderate fatty changes in the livers of high-dose TRCP-treated rats which died during the first study week were probably related to chloropropene exposure. Treatment-related necrotic/degenerative lesions of the liver were seen in both male and female rats administered 300 mg/kg/d TECP.