Interaktion von HWS mit Kau- und Kieferapparat

Both the cervical spine and the masticatory organs and jaws can cause local and generalised symptoms. Depending on the patient’s age, there is a close interaction between the two regions. While during early development the influence of the cervical spine in pathology of cervicomandibular function is greater, in the course of adolescence the significance of the jaw and the teeth increases more and more. In adulthood, finally, the pathomorphological impairment potential of the jaw region is dominant. Differentiation between the acute findings (e.g. between cervical spine and jaw region as the main problem area) is offset by analysis of the time axis (what type of patient do we have before us?). If the KiSS (Kopfgelenkinduzierte Symmetrie-Störung [impairment of symmetry attributable to the atlanto-axial and atlanto-occipital joints]) symptom complex offers a diagnostic/anamnestic concept for assessment of the ontogenetic relevance of vertebrogenic problems and can make it easier to decide on where the emphasis of treatment should be. Functional irritations that have originated in the cervical spine can thus be recognised earlier, and in children it can be possible to avoid malformations in the orofacial region. This approach also allows better understanding of the complex interaction between manual medicine and dentistry.     

Normal morphology of sacroiliac joints in children: magnetic resonance studies related to age and sex

Objective. To determine in a prospective study the normal MRI morphology of the sacroiliac joints (SIJs) in relation to age and sex during adolescence. Design and patients. A total of 98 children (63 boys, mean age 12.7±2.8 years; 35 girls, mean age 13.7±2.3 years), ranging in age from 8 to 17 years, with juvenile chronic arthritis (JCA) but without signs of sacroiliitis fulfilled the study prerequisites (no back pain and no pathologic changes of the SIJs on physical examination before MRI in a 1.5-year follow-up). An additional eight HLA-B27-negative boys and eight HLA-B27-negative girls without arthritis served as controls. The MRI protocol comprised a T1-weighted SE sequence, an opposed-phase T2*-weighted GE sequence, and a dynamic contrast-enhanced study in single-section technique. Results. Noncontrast MRI permitted differentiation of “open” from ossified segmental and lateral apophyses of the sacral wings, with a significant difference in age (P <0.05) between children with open and ossified apophyses. Ossification of the apophyses of the sacral wings was seen significantly earlier (P <0.05) in girls than in boys. Girls also had a significantly higher incidence of transitional lumbosacral vertebrae, pelvic asymmetries, and accessory joints. In the contrast-enhanced opposed-phase MRI study, normal cartilage of the SIJs showed no contrast enhancement whereas the joint capsule showed a moderate enhancement. Conclusion. There are significant age- and sex-related differences in the normal MRI morphology of juvenile SIJs. Our findings might serve as a standard of comparison for the evaluation of pathologic changes – in particular for the early identification of juvenile sacroiliitis.     

Self-monitoring in patients with schizophrenia

BACKGROUND: The present study investigated whether a failure of self-monitoring contributes to core syndromes of schizophrenia. METHOD: Three groups of patients with a DSM-IV diagnosis of schizophrenia (n = 27), with either prominent paranoid hallucinatory or disorganization syndrome, or without these symptoms, and a matched healthy control group (n = 23) drew circles on a writing pad connected to a PC monitor. Subjects were instructed to continuously monitor the relationship between their hand movements and their visual consequences. They were asked to detect gain changes in the mapping. Self-monitoring ability and the ability to automatically correct movements were assessed. RESULTS: Patients with either paranoid-hallucinatory syndrome or formal thought disorder were selectively impaired in their ability to detect a mismatch between a self-generated movement and its consequences, but not impaired in their ability to automatically compensate for the gain change. CONCLUSIONS: These results support the claim that a failure of self-monitoring may underlie the core symptoms of schizophrenia.     

Reversal of established delayed type hypersensitivity reactions following therapy with IL-4 or antigen-specific Th2 cells

Delayed-type hypersensitivity reactions (DTHR) are mediated by IFN-gamma-producing CD4+ (Th1) or CD8+ T cells (Tc1) and can be prevented by steering T cells toward an IL-4-producing Th2 or Tc2 phenotype. It is currently accepted that T cells can be directed toward a Th2 or Tc2 phenotype only during the initiation of an immune response. Once established, the cytokine pattern of immune reactions is believed to be stable. Therefore, inhibition of DTHR by the induction of Th2/Tc2 responses, termed immune deviation, is considered only as a prevention but not as a therapy of harmful DTHR. Here we demonstrate that therapeutic immune deviation can reverse established contact hypersensitivity (CHS), a Th1/Tc1-mediated DTHR. One or two weeks after induction of CHS, mice received either a single cycle of IL-4 therapy or adoptive transfer of antigen-specific Th2 cells. This treatment generated a novel state of immunity that provided long-lasting protection against tissue destruction and neutrophil recruitment during subsequent antigen exposures. Therapeutic immune deviation of established CHS was dependent on CD4+ T cells and the induction of endogenous IL-4 synthesis. Thus, a population of immunoregulatory Th2 cells persists during advanced inflammatory responses that can be used for therapeutic deviation of established DTHR.     

Surface EMG-recordings using a miniaturised matrix electrode: a new technique for small animals

A new method for multichannel surface-EMG measurements in small animals is presented. The underlying scientific aim is the characterisation of the spreading and the co-ordination of skeletal muscle activation between different muscles or muscle parts, depending on various motor tasks. The myoelectrical signals were recorded monopolarly by a 16-channel matrix electrode on the muscle surface directly under the skin on the fascia of the investigated muscle, without damaging the muscle. Surface-EMG's were recorded for at least 5 days after surgery without electrical interferences. During defined motor tasks, the projection of the myoelectrical activation of the different parts of the M. triceps brachii of rats (Rattus norvegicus), pikas (Ochotona rufescens) and cuis (Galea musteloides) or the M. anconeus of toads (Bufo marinus) on the muscle surface was mapped. The locomotion of the investigated animals was monitored by a three-dimensional kinematic analysis (video and/or high-speed cineradiography). There was no perceptible influence from application of EMG matrix electrode. The miniaturised matrix electrode seemed practicable in gaining insight into changes in myoelectrical activation patterns (EMG mapping). This allows a characterisation of the intramuscular co-ordination processes corresponding to the actual morphofunctional state of the investigated animals.     

Wheat‐dependent exercise‐induced anaphylaxis

Wheat‐dependent exercise‐induced anaphylaxis (WDEIA) is a rare, but potentially severe food allergy exclusively occurring when wheat ingestion is accompanied by augmenting cofactors. It is clinically characterized by anaphylactic reactions ranging from urticaria and angioedema to dyspnoea, hypotension, collapse, and shock. WDEIA usually develops after ingestion of wheat products followed by physical exercise. Other cofactors are acetylsalicylic acid and other non‐steroidal anti‐inflammatory drugs, alcohol, and infections. The precise mechanisms of WDEIA remain unclear; exercise and other cofactors might increase gastrointestinal allergen permeability and osmolality, redistribute blood flow, or lower the threshold for IgE‐mediated mast cell degranulation. Among wheat proteins, ω5‐gliadin and high‐molecular‐weight glutenin subunits have been reported to be the major allergens. In some patients, WDEIA has been discussed to be caused by epicutaneous sensitization with hydrolysed wheat gluten included in cosmetics. Diagnosis is made based on the patient's history in combination with allergy skin testing, determination of wheat‐specific IgE serum antibodies, basophil activation test, histamine release test, and/or exercise challenge test. Acute treatment includes application of adrenaline or antihistamines. The most reliable prophylaxis of WDEIA is a gluten‐free diet. In less severe cases, a strict limitation of wheat ingestion before exercise and avoidance of other cofactors may be sufficient.