Bite force in patients with functional disturbances of the masticatory system

In thirty patients (24 women and 6 men) treated because of dysfunction of the masticatory system at the department of Stomatognathic Physiology, University of Gothenburg, bite force was registered before, during and after treatment had been completed. In the controls, thirty-six dental students and trainee dental nurses, with no dysfunction of the masticatory system, bite force was registered on two occasions. Bite force was measured between the first molars on each side and between the central incisors. Also finger force was registered. The force measurements were made at five different levels, increasing from very weak to maximum force. Repeated tests of bite force in the control group, made at intervals of about 1 week, gave almost identical results. Bite force in the patient group was lower than in the control group at the first registration but increased with palliation of the symptoms during treatment. There was no significant difference in bite force between the affected and the unaffected side.     

ALTERATIONS IN MAST CELL PROTEINASES AND PROTEASE INHIBITORS IN THE PROGRESS OF CUTANEOUS HERPES ZOSTER INFECTION

The possible involvement of mast cell proteases in the cutaneous inflammation of herpes zoster was studied histochemically in ten patients. Mast cell tryptase and chymase bioactivities were demonstrated enzyme-histochemically. The localization of protease inhibitors as well as tryptase and chymase proteins in mast cells was established using a sequential double-staining method which first demonstrated bioactive tryptase or chymase, followed by immunohistochemical identification of these antigens. Biopsies were taken from involved vesicular and erythematous skin, as well as from normal healthy-looking skin. Tryptase-bioactive mast cells were significantly lower in number in the upper, but not in the deeper dermis of vesicular skin (68±37 cells/mmmean±SD) when compared with either healthy-looking (97±38) or erythematous skin (105±36) ( t -test, P <0·005). In contrast, chymase-bioactive mast cells were significantly reduced in number both in erythematous skin (44±20, P <0·02) and even more so in vesicular skin (26±20, P <0·0005) when compared with healthy-looking skin (64±27). The percentage of α₁-antitrypsin-immunoreactive and α₁-antichymotrypsin-immunoreactive mast cells in the upper dermis increased steadily from the values in healthy-looking skin (37·9±18·8 and 82·5±21·6 per cent) to those in erythematous (64·4±16·4 and 93·5±7·9 per cent) and vesicular skin (75·2±10·2 and 96·4±4 per cent). A novel finding was that cells showing tryptase immunoreactivity but no enzyme activity were found in two out of nine erythematous skin specimens and in four out of seven vesicular specimens. In healthy-looking skin, all cells with chymase immunoreactivity also displayed chymase bioactivity, but only 53·2±24·25 per cent of these mast cells in erythematous lesions and 44·4±15·9 per cent in vesicular lesions showed chymase bioactivity, suggesting inactivation of chymase by protease inhibitors. These results show prominent alterations in mast cell proteinases and protease inhibitors, indicating that these enzymes participate in the cutaneous inflammation due to herpes zoster.     

On the Methylation of Ethanol Amine,Dimethyl Ethanol Amine,Guanidine Acetic Acid and Homocysteine

By means of the colorimetric method of MCCARTHY and SULLI-VAN for the determination of methionine in biological mixtures, an investigation is made of the methylation of ethanol arnine, dimethyl ethanol amine, glycocyamine and homocysteine. The results extend and corroborate those of previous investigations.     

Atrial Sensing and AV Synchrony in Single Lead VDD Pacemakers: A Prospective Comparison to DDD Devices with Bipolar Atrial Leads

INTRODUCTION: Single lead VDD pacing has offered an alternative to DDD systems in patients with isolated AV block. Up to now, however, the relative performance of these pacemaker systems was not systematically compared. METHODS AND RESULTS: Three hundred sixty patients who received either a VDD pacemaker (n = 180) or a DDD device (n = 180) with a bipolar atrial lead were investigated prospectively for a mean period of 30 +/- 13 months. Pacemaker function was analyzed by telemetry, Holter monitoring, and exercise ECG. Time of implantation and fluoroscopy was significantly lower with VDD devices (44.3 +/- 5.1 min vs 74.4 +/- 13.5 min and 4.6 +/- 2.5 min vs 10.3 +/- 5.6 min in DDD pacemakers, respectively). Intermittent atrial undersensing occurred in 23.3% of patients with a VDD pacemaker and in 9.4% with DDD devices (NS). The incidence of atrial tachyarrhythmias did not differ between the VDD (6.7%) and the DDD group (6.1%). Sinus node dysfunction developed in 1.9% of patients, but the vast majority (85.7%) of patients were asymptomatic. There was a tendency for a higher rate of operative revisions in the DDD group (6.1% vs 3.3% in VDD pacemakers, P = 0.15). Cumulative maintenance of AV-synchronized pacing mode was 94.9% in patients with VDD pacemakers and 92.1% with DDD devices (NS). CONCLUSION: With the benefit of a simpler implant procedure, long-term outcome of single lead VDD pacing is equivalent to DDD pacing in patients with AV block and preoperative normal sinus node function.     

Adverse Pacemaker Hemodynamics Evaluated by Pulmonary Venous Flow Monitoring

The pacemaker syndrome refers to symptoms and signs in the pacemaker patient caused by an inadequate timing of atrial and ventricular contractions. The lack of normal atrioventricular synchrony may result in a decreased cardiac output and venous cannon A waves. The objective of this study was to define the left atrial and pulmonary venous flow response to ventricular pacing in a group of 14 unselected consecutive patients with total heart block and sinus rhythm. Pulmonary venous flow was assessed by transesophageal pulsed Doppier echocardiography in the VVI and ODD pacing modes. An inappropriate atrial timing caused a marked augmentation of the normally small pulmonary venous z wave in all patients ("negative atrial kick" peak z wave in DDD pacing 14.5 ± 4.6 cm/s, VVI pacing 51.8 ± 15.0 cm/s). Restoration of AV synchrony (DDD pacing, AV interval 100 ms) abolished these "cannon z waves" in all patients, and a normal pattern of pulmonary venous flow was achieved. Abnormal pulmonary venous flow characteristics were observed in 2 of 14 patients during DDD pacing with short AV intervals (100 ms). The Doppier pattern was similar to the findings seen in VVI pacing. Assessment of pulmonary venous flow by transesophageal pulsed Doppier echocardiography may provide a simple, sensitive, and relatively noninvasive technique to evaluate patients with suspected pacing induced adverse hemodynamics.     

BENIGN PAROXYSMAL TORTICOLLIS IN INFANCY

Abstract. Benign paroxysmal torticollis is a condition characterized by attacks of head-tilting often accompanied by lateral curvature of the trunc. The first onset of these attacks usually occurs during the first months of life and they recur with a remarkable periodicity for 6–12 months after which time they gradually subside in intensity and frequency. As a rule the attacks have ceased completely before the age of 2 years but in some cases they continue in a modified form as attacks of ataxia. The aetiology is unknown and there is no evidence of bilateral peripheral vestibular disturbances as has been suggested in earlier reports. The ataxia seen in some cases rather suggests a dysfunction of the cerebellum or of the vestibulo-cerebellar connections. Four own patients with this syndrome are presented and discussed.