Relationship between osteopathic manipulative treatment of the temporomandibular joint, molar shim and the orthostatic position: A randomized, controlled and double blinded study.

This randomized, controlled, double-blinded study related the effect of osteopathic manipulative treatment (OMT) of the temporomandibular joint (TMJ) and the orthostatic posture using the molar shim (MS) as a postural adjustment factor. Twenty individuals classified with temporomandibular disorder (TMD) were randomly assigned to a treated group (TG, n = 10) and placebo (PG, n = 10). The independent variables were: MS and OMT of the TMJ. The dependent variables were: DC-TMD data; local pressure pain using algometry; and orthostatic posture assessed by the distribution of plantar pressures (baropodometry), in the evaluation periods before and immediately after the interventions. Results: pain did not show a statistically significant difference after the interventions. However, when comparing the Effect Size (ES) between the groups in the post-intervention moment, a moderate relationship was observed for the left trapezius muscle (0.51) and right and left TMJ (0.41 and 0.54 respectively). When correlating the pain and percentage of anteroposterior postural dislocation variables, a significant moderate inverse correlation was observed in the post-intervention moment. The results of the MS pointed to a significant decrease (p ≤ 0.05) of the average peak pressure (Medium P) during the use of the MS (503.4 ± 44.1 kgf/cm2) and after performing the OMT (516.5 ± 49.6 kgf/cm2), both for the TG compared to the pre intervention moment (519.3 ± 42.9 kgf/cm2). There is a correlation between TMJ and orthostatic posture. OMT of the TMJ influences orthostatic posture. The MS can be added to the evaluative context of TMD.

Effect of bioactive proteins on gait kinematics and systemic inflammatory markers in mature horses.

Twenty-seven mature Quarter horses were used in a randomized design to determine the effects of bioactive protein supplementation on gait kinematics and systemic inflammatory markers in a 34-d trial. Treatments consisted of oral doses of 230 g/d of pelleted supplements containing 0 g (CON; n = 9), 40 g of bioactive protein (40BP; n = 9; LIFELINE, APC, LLC, Ankeny, IA), and 80 g of bioactive protein (80BP; n = 9) daily. Horses were fed a commercial concentrate at 0.5% BW (as-fed) and received ad libitum coastal bermudagrass (Cynodon dactylon) hay daily. On day 33, horses consistent in exercise (CON, n = 6; 40BP, n = 8; 80BP, n = 7) participated in a trailering and riding challenge. Kinematic gait analysis was performed on day 0 for use as a covariate, and on day 14, 28, and 34 to allow for the determination of potential time and dosage effects. Video footage was collected and analyzed using gait analysis software (EquineTec, Monroe, GA) for the determination of stride length (SL) and range of motion (ROM). Blood was collected via jugular venipuncture on days 0, 14, 28, and 34 for determination of systemic expression of tumor necrosis factor (TNF)-α and IL-1ß. Data were analyzed using PROC MIXED of SAS. A trend towards treatment × time interaction was observed in ROM of the knee at the walk (P = 0.10), due to the increasing ROM for 40BP and 80BP as time increased and decreasing ROM for CON. A treatment × time interaction was observed (P < 0.01) for hock ROM at a walk resulting from CON and 80BP decreasing from day 14 to 28 with 40BP increasing, while from day 28 to 34 ROM at a walk decreased for 40BP and increased for 80BP. The main effect of treatment on hock ROM at the walk was quadratic (P < 0.01) and characterized by higher ROM values for 40BP compared to CON or 80BP. Dietary treatment lengthened (P = 0.04) SL of the hind limb at the walk for 40BP and 80BP compared to CON on both days 14 and 28. A significant treatment × time interaction was observed in the expression of IL-1ß (P < 0.01) and can be explained by lower concentrations of IL-1ß for 80BP on day 34 compared to the other treatments, with 40BP being intermediate and CON being the highest. Increased articular ROM with decreased expression of IL-1ß may indicate potential anti-inflammatory effects of 80 g/d of bioactive proteins.

Effect of maternal overnutrition on predisposition to insulin resistance in the foal: Maternal parameters and foal pancreas histoarchitecture.

Results from previous studies indicate that maternal overnutrition during late gestation predisposes foals to metabolic disease, however, specific mechanisms resulting in disease remain unknown. Quarter Horse mares (n = 16), were randomly assigned to dietary treatments, beginning on gestational day 235, and consisted of a control group (CON- diet meeting nutrient requirement; n = 8) or an overfed diet (HIGH; n = 8) where mares received an additional 40 % above CON. On gestational days 285 and 315, an intravenous glucose tolerance test (FSIGTT) was conducted. Following parturition, foals were separated from the mare, prohibited from nursing, and an FSIGTT was conducted at 2 h postpartum. Foals were immediately euthanized and tissues preserved for analyses. There was no effect of treatment on foal BW (P = 0.50), pancreas weight (P = 0.60), or FSIGTT area under the curve for glucose (P = 0.80) and insulin (P = 0.70). Colocalization of α-amylase to isolate pancreatic islets of Langerhans indicated increased islet number and size in foals from HIGH mares (P < 0.01). Immunofluoresent analysis of insulin, glucagon, and somatostatin indicate no difference in intensity of staining (P> 0.10). Foals exposed to overnutrition during peak fetal growth had altered pancreatic islet development that may lead to adult-onset metabolic disease.

[Long-term Application of Opioids for Non-Tumor Associated Pain--Impact of the S3 Guidelines for the Field of Orthopaedic Surgery and Trauma Surgery]. / Langzeitanwendung von Opioiden bei nicht tumorbedingten Schmerzen: Bedeutung der S3-Leitlinie LONTS für das Fachgebiet Orthopädie und Unfallchirurgie.

BACKGROUND: The S3 guidelines for long-term application of opioids for non-tumour-associated pain, the so-called "LONTS", have recently been updated. German health insurance data indicated that over the last 3 to 4 years an increasing number of patients have been treated with opioids for non-tumour-associated pain. Many patients with somatoform pain disorder were treated with opioids. The S3-guidelines have therefore been modified after 5 years on the basis of a systematic literature search. METHODS: Seventeen experts in the field were appointed. In addition, among 25 medical societies, one psychological society, two patient support groups, and the DGOOC and IGOST were involved in the decision making process. RESULTS: According to the updated S3 guidelines "LONTS", opioids are a valuable treatment option in the field of orthopaedics and trauma surgery for patients suffering from chronic arthritis or back pain. One third of the patients suffering from chronic arthritis or knee pain benefit from long-term application (< 26 weeks) and show pain relief, as well as improved range of motion without severe drug-induced side effects. Patients suffering from fibromyalgia syndrome benefited from treatment with tramadol, but no other opioid is recommended for fibromyalgia. Opioids are contraindicated in primary headaches, as well as in functional and psychological disorders with pain as the leading symptom. Treatment with opioids is associated with considerable risks, among them substance abuse, sexual dysfunction and an increased mortality rate. Supportive measures, such as physical therapy, physiotherapy and/or psychotherapy, are always recommended. DISCUSSION: Opioid analgetics are a treatment option for particular pain syndromes (arthritis, back pain). However, the latest S3 guidelines emphasise patient education and therapy. The indication, effects, side effects and therapeutic objectives should be regularly assessed, both before and during treatment. Once therapeutic goals have been achieved, measures such as physical therapy, physiotherapy or psychotherapy should be continued, whereas opioid dosage should be gradually reduced.

Identification of a plane pollen lipid transfer protein (Pla a 3) and its immunological relation to the peach lipid-transfer protein, Pru p 3.

BACKGROUND: An association between plane tree pollen allergy and plant food allergy has been described, but the cross-reacting allergens have not yet been identified. The aim of this study was the identification of homologous non-specific lipid-transfer proteins (nsLTPs) in plane pollen, and to investigate its immunological relationship with the peach LTP, Pru p 3. METHODS: Three different patient groups were recruited in Spain: 22 plane pollen-allergic patients without food allergy (A), 36 plane pollen-allergic patients with peach allergy (B) and 10 peach-allergic patients without plane pollen allergy (C). Proteins from plane pollen extract were fractionated by ion-exchange and reversed-phase chromatography. Further methods applied were N-terminal amino acid sequence analysis, immunoblotting, enzyme allergosorbent test, CAP and basophil histamine release assays. RESULTS: A 10 kDa IgE-reactive protein was purified from plane pollen and identified as nsLTP. Pla a 3 was characterized as a minor allergen (27.3%) in plane pollen-allergic patients without food allergy (A) and as a major allergen in plane pollen-allergic patients with peach allergy (B) showing a prevalence of IgE-reactivity of 63.8%. Group B contained patients sensitized to Pru p 3 without IgE-reactivity to plane-LTP (16.6%). By contrast, Pla a 3 IgE-reactive patients without sensitization to Pru p 3 could be found (16.6%). The sera of patients sensitized to both LTPs (50%), Pla a 3 and Pru p 3, showed different biological activity in histamine release assay: depending on individual patient's sera tested, Pla a 3 showed a similar, a stronger or a weaker allergenic potency in comparison with Pru p 3. CONCLUSIONS: Plane LTP is a major allergen in plane pollen-allergic patients with peach allergy recruited in the Mediterranean area. The results of histamine release tests and different IgE-binding profiles pointed towards the existence of species-specific IgE epitopes. Likewise, no general conclusion on the sensitizer could be made.

Clinical field testing of polyurethane feet for trans-tibial amputees in tropical low-income countries.

In a prospective controlled study, 172 polyurethane feet of different designs were fitted to 155 amputees with trans-tibial prostheses. These were followed in respect of their durability. The amputee compliance was in general good, and 87% were satisfied with their device. After 18 months the failure rate of 20% with the CIREC spring-blade foot was significantly better than the others, but poorer craftsmanship, higher complaint rate and lower compliance rate cast some doubt on the results. The results with the conventional SACH foot constructions with polyurethane as filling and covering materials were so poor after 18 months that their use cannot be recommended in tropical areas of the developing world.

Clinical field testing of vulcanized rubber feet for trans-tibial amputees in tropical low-income countries.

In a prospective, controlled study, 186 prosthetic rubber feet of different designs were fitted to amputees with trans-tibial prostheses. There were 158 amputees available for follow-up. The amputee compliance was good and 89% were satisfied with their device. After 18 months of use one VI-Solid rubber foot from VVAF in Cambodia had failed, as compared to 11% failures with the same foot with a heel cavity, 3% with the EB-1 sandwich construction from POF in Vietnam, all performing significantly better than the 62% encountered with the vulcanized rubber foot from ICRC in Cambodia; the latter representing half of the feet failing in amputees walking bare-footed. Nearly all failures were located at the foot-sole or the keel. The failure rate was 20% for the HI-Cambodia foot after 12 months. After 24 months of use, still only one VI-Solid rubber foot had failed and this foot design was found superior to the others in regard of durability.

Ascitic fluid albumin and water flows in patients with alcoholic cirrhosis: effects of peritoneovenous shunting.

Ascites labeled albumin and water kinetics were studied at steady state by intercompartmental clearances in cirrhotic patients whose ascites volumes ranged from 6.4 to 25.2 L. In 20 patients mean (+/- SD) ascitic fluid albumin clearance (equivalent to lymphatic absorption) was 3.5 +/- 1.9 L/day. In seven of them, lymphatic absorption was 3.4 +/- 0.8 L/day, total water absorption from ascitic fluid (outflow equals inflow at steady state) was 125.8 +/- 21.5 L/day. Vascular capillary water absorption (total minus lymphatic) was 122.4 +/- 21.4 L per 24 hours. Lymphatic absorption was less than 4% of total but accounted for all albumin absorbed (13.2 +/- 6.2 gm/day). Maximum lymphatic absorption was less than 10 L per 24 hours; peritoneovenous shunting augmented this function. Mean inflow water albumin concentration was 0.11 +/- 0.06 gm/L. If plasma albumin were diluted to concentration in ascites, calculated water inflow required would be 2.82 L/day. Actual inflow was 47 times that required. The major volume outflow path was through peritoneal venous capillaries; water and small-radius solute absorption through this route increased inflow water albumin concentration to ascites level. Concurrently, whole ascitic fluid was absorbed without sieving through lymphatics. Observed ascites albumin concentration in subjects with advanced cirrhosis was produced by water absorption from a large volume of dilute solution rather than dilution of a small inflow volume, in which albumin concentration originally was hyperoncotic to ascitic fluid. Large-volume transperitoneal water diversion from sources in high-pressure, extrahepatic splanchnic capillaries to absorption through parietal nonportal, low-pressure, peritoneal venous capillaries would significantly reduce portal plasma flow into liver and have deleterious systemic hemodynamic consequences.

Video-assisted thoracoscopic surgery--indications, results, complications, and contraindications.

In recent times minimally invasive surgery has secured a firm place among the therapeutic options in thoracic surgery. The experience and results gained from video-assisted surgery on 109 patients between January 1, 1992 and July 31, 1993 are critically discussed. The procedure could be completed thoracoscopically on 94 of them. A change of method was necessary nine times for technical reasons and six times for oncological reasons (two times due to metastasis, four times due to bronchial carcinoma). A total of 154 individual operations were conducted. Sixty-three patients with recurrent spontaneous pneumothorax were successfully treated. The relapse rate was 1.5%. With the exception of three rethoracotomies (one due to postoperative hemorrhaging and two to persistent fistula) no significant complications occurred. Further indications included capsulated pleural empyema (n = 1), persistent hematothorax (n = 2), pleurectomy for malignant pleural effusion (n = 2), pleural tumors (n = 3), pulmonary parenchyma (n = 2), interstitial lung diseases (n = 3), bullous emphysema (n = 2), peripheral lung nodules (n = 18), mediastinal tumors (n = 8), and sympathectomy (n = 2). The advantages of video-assisted thoracoscopic surgery for patients include cosmetic considerations, low pain, earlier postoperative mobilization, and for some indications, a shorter operation period. The significant disadvantages for the surgeon are the loss of binocular vision as well as the impossibility of intraoperative palpation.

The pronator teres syndrome: compressive neuropathy of the median nerve.

Thirty-nine patients with a clinical diagnosis of the pronator teres syndrome were seen during a seven-year period. They typically complained of aching discomfort in the forearm, weakness in the hand, and numbness in the thumb and index finger. Cyclic stress usually brought on the symptoms. The distinctive physical finding was tenderness over the proximal part of the pronator teres, which was aggravated by resisted pronation of the forearm, flexion of the elbow, and occasionally by resisted contraction of the flexor superficialis of the long finger. Electrophysiological testing of the median nerve showed abnormalities in a few patients, but localization of the abnormality was possible only rarely. Intraoperative recordings showed some improvement shortly after release of the median nerve in six of the ten forearms that were tested. Surgical exploration of thirty-six forearms in thirty-two patients showed intramuscular tendinous bands in the pronator, indentation of the muscle belly of the flexor superficialis in most forearms. Vascular and muscular abnormalities were seen occasionally. Of the thirty-six operations, twenty-eight gave good or excellent results; five, fair; and in three patients the symptoms were unchanged. The cause of failure was either inadequate decompression or misdiagnosis.

Long-term results of resection of the distal ulna for post-traumatic conditions.

Sixty-two patients underwent resection of the distal ulna because of pain or limited motion after wrist trauma. The median length of resection was 23 mm. Injury to the distal radioulnar joint occurred primarily during fractures of the distal radius. Followup time averaged 87 months. The primary surgical indication was pain, but some procedures were performed in an effort to increase motion. All patients improved after surgery. Three patients had residual pain, 25 had mild pain, and 34 had no pain. Supination was greatly improved, with only modest improvement in other wrist motions. Four patients developed ulnar translation of the carpus (from 1 to 3 mm). Pseudoarticulation and ulnar regrowth of the carpus were noted, but neither pseudoarticulation nor regrowth was clinically symptomatic. Grip strength improved significantly after surgery, the average from 45.3 to 78.9% of the unaffected wrist. The presence or absence of radiocarpal arthritis preoperatively had no significant effect on the patients' estimates of results. Overall, 51 patients (82%) had satisfactory results. The primary gains were pain relief, increased supination, and increased strength.