Computed tomography and bone scintigraphy in the evaluation of tarsal coalition

Three cases of talocalcaneal coalition were evaluated with routine radiography, conventional tomography, 99mTc-MDP bone scintigraphy, and computed tomography (CT). Routine radiography was normal in 1 case and demonstrated secondary findings suggesting coalition in 2. Conventional tomography confirmed the coalition in 2 patients. In all 3 cases, the scintigrams demonstrated increased uptake in the region of the coalition. CT provided the most graphic depiction of the coalition site and also identified an associated lesion involving the posterior subtalar joint, not recognized on conventional tomography. Scintigraphy may be useful as a screening procedure and can provide important localizing information in difficult cases.     

Does long‐term use of unstable dentures weaken jaw muscles?

Summary Although it is well known that conventional denture wearers have lower maximum bite forces than dentate subjects, no previous studies have compared the strength of the jaw muscles between these two groups. This study compared maximum bite forces, electromyographic (EMG) activity and estimated jaw muscle strength among three groups: (i) 17 edentulous subjects using newly acquired implant‐retained overdentures (seven men, 10 women; mean age 60·3 ± 13·0 years); (ii) 10 age‐matched, fully dentate subjects (five men, five women; mean age 57·9 ± 11·0 years); and (iii) 39 young, fully dentate subjects (19 men, 20 women; mean age 24·4 ± 3·5 years). Electromyographic activity was recorded from subjects’ bilateral superficial masseter and anterior temporalis muscles while they generated maximum voluntary bite forces at the right central incisor, right first premolar and right first molar positions. Jaw muscle strength was estimated as the ratio of average EMG activity for all four muscles to the maximum bite force. At all three bite positions, edentulous subjects produced maximum bite forces that were less than half that of dentate subjects. Edentulous subjects also produced significantly less EMG activity and had significantly lower estimated jaw muscle strength. Our results suggest that weakened jaw muscles are one factor contributing to lower maximum bite forces among users of conventional dentures.     

Reproductive decision‐making in the context of mitochondrial DNA disorders: views and experiences of professionals

Bredenoord AL, Krumeich A, De Vries MC, Dondorp W, De Wert G. Reproductive decision‐making in the context of mitochondrial DNA disorders: views and experiences of professionals. Although a scientific and ethical debate about the possible reproductive options for carriers of mitochondrial DNA (mtDNA) mutations is developing, not much information regarding the views and experiences of professionals exists. This paper explores the attitudes and experiences of professionals involved on a daily basis with their patients' reproductive decision‐making in the context of mtDNA disease. Qualitative international multicenter design using in‐depth semi‐structured interviews with 20 professionals has been utilized. We identified four main themes emerging from the interviews. Firstly, we illustrate the discussion among professionals as to what extent mitochondrial genetics differs from other areas in genetics, both technically and ethically. Secondly, we show the discomfort and doubts of professionals when an mtDNA mutation is involved, because of the uncertainty remaining after testing. Thirdly, we discuss how professionals struggle with the tension between, on the one hand, the ideal of reproductive autonomy and, on the other hand, the reality of their professional responsibility and complex clinical decision‐making. Fourthly, we delineate the strategies used by professionals in order to make attempts to control uncertainty. This paper illustrates the impact on professionals of reproductive decision‐making in the context of mtDNA disease. It shows their feelings of discomfort when interpreting and explaining uncertain or ambiguous data and may be perceived as an example of how professionals deal with the inherent limitations in genetic knowledge representing the state of the art. Insight into the experiences of professionals may contribute to a further improvement of reproductive genetic counseling in the context of mtDNA disorders.