Evaluating the benefits of patterned stimulation in the treatment of osteoarthritis of the knee: a multi-center, randomized, single-blind, controlled study with an independent masked evaluator.

OBJECTIVE: This study investigated the benefits of the combination of interferential (IF) and patterned muscle stimulation in the treatment of osteoarthritis (OA) of the knee. DESIGN: This was a multi-center, randomized, single-blind, controlled study with an independent observer. The study randomized 116 patients with OA of the knee to a test or control group. The test group received 15 min of IF stimulation followed by 20 min of patterned muscle stimulation. The control group received 35 min of low-current transcutaneous electrical nerve stimulation (TENS). Both groups were treated for 8 weeks. Subjects completed questionnaires at baseline and after 2, 4 and 8 weeks. Primary outcomes included the pain and physical function subscales of the Western Ontario MacMaster (WOMAC) OA Index and Visual Analog Scales (VAS) for pain and quality of life. RESULTS: Compared to the control group, the test group showed reduced pain and increased function. The test group showed a greater decrease in the WOMAC pain subscale (P=0.002), function subscale (P=0.003) and stiffness subscale (P=0.004). More than 70% of the test group, compared to less than 50% of the control group, had at least a 20% reduction in the WOMAC pain subscale. When analyzing only patients who completed the study, the test group had a nominally significant greater decrease in overall pain VAS. No significant between-group differences were observed in incidence of adverse events. CONCLUSIONS: In patients with OA of the knee, home-based patterned stimulation appears to be a promising therapy for relieving pain, decreasing stiffness, and increasing function.

Using absorbable collagen membranes for guided tissue regeneration, guided bone regeneration, and to treat gingival recession.

This article reviews the role of barrier membranes in guided tissue regeneration (GTR) and guided bone regeneration (GBR), including the advantages of using absorbable barrier membranes in GTR and GBR and the unique properties of collagen membranes. The indications and contraindications for using collagen membranes for these procedures are examined, and successful cases are presented. Finally, the role of collagen membranes in the future of regenerative therapy is considered.

MR findings in oculocerebrorenal syndrome.

Oculocerebrorenal syndrome is an X-linked recessive disorder characterized by congenital ocular abnormalities, mental retardation, renal disease, and metabolic bone disease. We report a case of oculocerebrorenal syndrome and, using T1-, proton density-, and T2-weighted imaging sequences, are able to characterize two distinct white matter abnormalities: one lesion is punctate and has signal characteristics that parallel that of cerebrospinal fluid; a second lesion, found in association with the first, consists of patchy white matter abnormalities that are hypointense on T1-weighted images but hyperintense on proton density- and T2-weighted images.

The effects of the Le Fort I osteotomy on the periodontium.

Two age-matched populations of equal size (n = 40), one having orthodontic therapy and the other combined orthodontic therapy and orthognathic surgery, were evaluated for their periodontal status 1 to 10 years posttherapy. The parameters investigated were plaque index, gingival index, tooth mobility, width of keratinized tissue, probing depth, gingival recession, and attachment level. No significant differences were found (P less than .05). Within the surgery group, patients with maxillary osteotomies segmentalized between the central incisors (n = 11) and between the canines and second premolars (n = 12) were evaluated using the same parameters and compared with their nonsegmental counterparts. No significant differences were found for patients with osteotomies segmentalized between the central incisors. However, a statistically significant increase in probe depth and loss of attachment level of up to 0.3 mm was found at the sites of osteotomies segmentalized between the canine and second premolar (P less than .05). This difference was not considered clinically significant.

Retinal histamine synthesis is increased in experimental diabetes.

We examined retinal de novo histamine synthesis mediated by retinal histidine decarboxylase in normal and streptozotocin-diabetic male, Sprague Dawley rats that were diabetic for 21 days. We also examined effects of insulin and alpha-hydrazinohistidine (alpha HH) treatments on retinal histamine synthesis in this diabetic model. alpha HH is a specific inhibitor of histidine decarboxylase. Results indicate that the retina contains an active histidine decarboxylase enzyme system, and that in streptozotocin diabetes retinal histamine synthesis is increased 197%. Both insulin and alpha HH independently reverse and normalize retinal histamine synthesis. These data thus indicate that the retinal inducible histamine pool is increased in experimental diabetes, and that insulin is an important modulator of retinal histamine metabolism. This newly described retinal metabolic alteration may be one factor responsible for increased retinal vascular permeability in diabetic retinopathy.

Simple application of anterior jig or leaf gauge in routine clinical practice.

Utilization of either of the two described methods by dentists is recommended as a simple means to routinely record or provide centric relation closures. The leaf gauge (1 to 6 mm thick) can be made from plastic or x-ray film or it can be purchased. The anterior acrylic resin jig can be made in a few minutes directly in the mouth by the dentist or an assistant or by a technician using mounted casts. Both methods avoid adaptive mandibular closure patterns and dentist-guided jaw closure as well as other commonly unrecognized errors in assessing occlusal contacts.

Aortic histamine synthesis and aortic albumin accumulation in diabetes: activity-uptake relationships.

The relationship between inhibition of aortic histamine synthesis induced by varied dosages of alpha-hydrazinohistidine (alpha HH) and aortic uptake of fluorescein-labeled bovine serum albumin (FITCBSA) was examined in 40 male Wistar rats made diabetic by streptozotocin. Compared to nondiabetic animals, aortic uptake of FITCBSA in untreated diabetic animals was increased 43%. alpha HH administration produced essentially a complete inhibition of this accelerated histamine synthesis in diabetic animals at all dosages examined and likewise prevented an increase in aortic FITCBSA uptake among these animals. In diabetic animals, aortic histamine synthesis and aortic FITCBSA uptake showed a significant, strong positive correlation (r = 0.822, P less than 0.001) when examined in relation to the degree of inhibition of accelerated aortic histamine synthesis achieved among the individual animals. These data support the hypothesis that elevations in de novo aortic histamine formation, and thus elevations in the inducible histamine pool, are responsible, at least in part, for increased aortic uptake of macromolecules in diabetes. Since increases in various permeability characteristics occur early in atherogenesis, these data also indicate that expansion of the nascent histamine pool occurring in diabetes may be an important factor in the predisposition of diabetics to atherosclerotic vascular disease.

Clinical experience with Biobrane biosynthetic dressing in the treatment of partial thickness burns.

Biobrane, a synthetic, bicomposite wound dressing, has been used to treat 17 patients with partial thickness burn wounds covering 0.5-12.5 per cent of the total body surface area (mean 4.4 per cent). In 16 patients we found complete healing of the wound after removal of the dressing, 6-15 days after the injury. In one patient, the wounds were determined on the third day post-injury to be deeper than initially suspected, and she was taken to the operating room for surgical debridement and grafting. Biobrane is an effective wound covering for clean, superficial partial thickness burns of limited extent; the simultaneous use of topical antimicrobial agents for such wounds is not necessary.

Administration of intravenous alcohol for prevention of withdrawal in alcoholic burn patients.

We studied the effects of intravenous alcohol infusions on 22 alcoholic burn patients admitted to our burn center. The relationship of infusion rates to blood alcohol levels was studied over a 3 to 8 day period of administration, and daily blood test results in liver function were followed. No patients had signs of withdrawal either during the infusion period or after the discontinuation of alcohol therapy. Our data suggest that the intravenous infusion of ethanol at rates of 0.02 to 0.06 g/kg per hour provides low but measurable blood alcohol levels (2 to 8 mg/100 ml), avoids sedation and toxic effects, and prevents the appearance of withdrawal symptoms in severely alcoholic burn patients.