Chest wall kinematics and respiratory muscle action in ankylosing spondylitis patients.

No direct measurements of the pressures produced by the ribcage muscles, the diaphragm and the abdominal muscles during hyperventilation have been reported in patients with ankylosing spondylitis. Based on recent evidence indicating that abdominal muscles are important contributors to stimulation of ventilation, it was hypothesised that, in ankylosing spondylitis patients with limited ribcage expansion, a respiratory centre strategy to help the diaphragm function may involve coordinated action of this muscle with abdominal muscles. In order to validate this hypothesis, the chest wall response to a hypercapnic/hyperoxic rebreathing test was assessed in six ankylosing spondylitis patients and seven controls by combined analysis of: 1) chest wall kinematics, using optoelectronic plethysmography, this system is accurate in partitioning chest wall expansion into the contributions of the ribcage and the abdomen; and 2) respiratory muscle pressures, oesophageal, gastric and transdiaphragmatic (Pdi); the pressure/volume relaxation characteristics of both the ribcage and the abdomen allowed assessment of the peak pressure of both inspiratory and expiratory ribcage muscles, and of the abdominal muscles. During rebreathing, chest wall expansion increased to a similar extent in patients to that in controls; however, the abdominal component increased more and the ribcage component less in patients. Peak inspiratory ribcage, but not abdominal, muscle pressure was significantly lower in patients than in controls. End-inspiratory Pdi increased similarly in both groups, whereas inspiratory swings in Pdi increased significantly only in patients. No pressure or volume signals correlated with disease severity. The diaphragm and abdominal muscles help to expand the chest wall in ankylosing spondylitis patients, regardless of the severity of their disease. This finding supports the starting hypothesis that a coordinated response of respiratory muscle activity optimises the efficiency of the thoracoabdominal compartment in conditions of limited ribcage expansion.     

Computer simulation of the occlusal anatomy of the first mandibular molar after varying the determinants of mandibular movement in the CICERO CAD/CAM system

Static and dynamic occlusal interferences often occur in restorations. The CICERO CAD/CAM technique was used to control the occlusal dimensions of all‐ceramic restorations by setting the variables which determine the mandibular contact movements. The anatomy of the occlusal form of the (pre)molar teeth is influenced by the setting of the sagittal and transversal determinants of mandibular contact movements. In this study the variation in occlusal morphology of a high‐ and low‐limit setting of six variables was compared with an averaged setting. The settings (high, low and averaged, respectively) of the mandibular movement: the sagittal condylar (60°, 0°, 30°) and the incisal guide angle (60°, 0°, 30°) as well as the long centric articulation (1·2 mm, 0 mm, 0·6 mm) influence mainly the antero‐posterior direction, whereas the settings of Bennett movement (laterotrusion: 30°, 0°, 15°), Bennett side shift (laterotranslation: 1, 0, 0·5 mm) and the wide centric (lateral intercuspal contact area: 0·6, 0, 0·3 mm) will mainly influence the transversal direction of the mandibular movement. The influence of the variation of settings on ‘dynamic’ crown morphology as compared with the static crown morphology was studied by comparison of mesio‐distal and bucco‐lingual sections at the same occlusal position of the first lower molar design. Furthermore, the amount of material needed for the correction of the ‘static’ crown to avoid interferences in dynamic conditions was calculated. It appeared that most correction was needed for the ipsilateral settings: Bennett side shift (1·0 mm), Bennett movement (30°) and the Sag. Condylar guidance (0°) as well as the Incisal angle (0°), which could be studied in the bucco‐lingual sections. Also the Bennett side shift on the contra‐lateral side influenced the occlusal contour strongly, which could be seen in the mesio‐distal section. It was concluded that simulation of the influence of several types of determinants of mandibular movement on the three‐dimensional occlusal anatomy can be studied using the CICERO‐CAD/CAM technique. The ipsi‐ and contralateral Bennett side shift variation influenced the occlusal anatomy more than other variables.     

Druckschmerzhafte Schwellung des Mittel- und Rückfußes während der Schwangerschaft

Ohne Zusammenfassung     

Aktueller Stellenwert von MRT, CT und PET in der Diagnostik des Zervixkarzinoms

MRI is estabished as a modality available for use in the diagnosis of cervical cancer. The soft tissue contrast it supplies is far better than that of any other method, making it the modality of choice for direct visualization of the carcinoma and thus also for tumor staging. Pelvic MRI performed as part of the pretreatment evaluation has been shown to be cost effective, and it is recommended for use in macroscopic cervical cancer in the guidelines of professional societies for gynecologists and oncologists. It has proved to be a reliable method for the early detection of recurrent tumors. It remains unsurpassed for accurate visualization of local tumor extent and involvement of adjacent pelvic organs in recurrent cervical cancer. It is also the method of choice for use in the planning of brachytherapy. With the increasing use of PET and PET/CT for investigations in oncology patients a second method has emerged. This seems to have advantages particularly in the detection of lymph node metastases by whole-body examination. Encouraging results on detection of recurrent cervical cancer during follow-up treatment by PET/CT have also been published, but a definitive assessment of the value of PET in tumor aftertreatment cannot be reached without more comparative studies against MRI. Moreover, there have so far been no studies evaluating the cost effectiveness of PET. In the near future it will be necessary to reconsider the new diagnostic modalities with reference to their accuracy in staging, since therapy is oriented increasingly to disease stage and increasingly specific treatment methods are applied.     

Screening of male patients with autosomal recessive Duchenne dystrophy through dystrophin and DNA studies

Previously we estimated that about 2.5-4% of isolated male patients diagnosed as Duchenne dystrophy (DMD) may have the autosomal recessive form (AR-DMD). Such cases can be distinguished from X-linked DMD through the analysis of dystrophin. Fifty DMD patients from 47 families were investigated for dystrophin and DNA deletions. Based on our results, we estimate that the frequency of AR-DMD may be about 8-12% among male patients diagnosed as DMD in whom X-linked inheritance could not be confirmed through pedigree data, serum enzymes in female relatives or DNA studies. Such an estimate must be confirmed in a larger sample; however, it shows the importance of assessing dystrophin in all patients diagnosed as DMD in whom X-linked inheritance cannot be proved, since the distinction between these 2 forms has implications for genetic counseling.