Being “the other therapist”: The varieties of adjunctive experience with hypnosis

Clinicians who utilize hypnosis in their practices are frequently approached with requests to participate in the care of patients who are currently in treatment with a primary therapist. Surprisingly, a review of the literature indicated that no research has been done on this common practice. This article provides a discussion of some of the important issues as well as the variables to consider in deciding whether to enter into this arrangement. It will serve as a starting point in generating further research on this crucial topic.     

Gastrocnemius recession: A cadaveric study of surgical safety and effectiveness

Background and purpose — Many methods of gastrocnemius lengthening have been described, with different surgical challenges, outcomes, and risks to the sural nerve. Our aims were (1) to locate the gastrocnemius muscular-tendinous junction in relation to the mid-length of the fibula (from here on designated the mid-fibula), (2) to compare the dorsiflexion achieved with dorsal recession or ventral recession, and (3) to determine the risk of injury to the sural nerve during gastrocnemius recession.

Methods — In 10 pairs of fresh-frozen adult cadaveric lower extremities transected above the knee, we measured dorsiflexion, performed dorsal or ventral gastrocnemius recession at the mid-fibula, and then measured the increase in dorsiflexion and fasciotomy gap. We noted the course of the sural nerve and whether the gastrocnemius muscle provided it with enough muscular coverage to protect it during recession.

Results — Dorsal and ventral recession produced statistically (p < 0.05) and clinically significant mean increases in dorsiflexion with extended knee from 12° to 19°, but they were not statistically significantly different from each other in this measure or in fasciotomy gap size. At the mid-fibula, the sural nerve coursed superficially between both heads of the gastrocnemius muscle in 14 of 20 specimens. Sufficient gastrocnemius muscle coverage to protect the sural nerve was provided by the medial head in 18 of 20 specimens and by the lateral head in only 5 of 20 specimens.

Interpretation — A ventral gastrocnemius recession proximal to the mid-fibula level poses less risk to the sural nerve than a recession at the mid-fibula. This procedure provides adequate lengthening (1–3?cm) and increased dorsiflexion (compared with baseline), with less risk to the sural nerve than is incurred with recession at the mid-fibular reference line.     

Chronic TM Disorder and Non-TM Disorder Pain: A Comparison of Behavioral and Psychological Characteristics

The purpose of this paper is to determine whether patients with chronic temporomandibular disorder (TMD) pain manifest behavioral, experiential, and psychological characteristics similar to patients with other chronic pain illnesses. The Chronic Pain Battery^TM (CPB), a multidimensional assessment tool for chronic pain patients, was used to compare several important variables between 78 TM disorder (TMD) patients and 98 non-TMD chronic pain patients. The study found that chronic TMD patients had lower “usual” pain intensity and suffering levels, fewer vegetative symptoms associated with depression, higher pain tolerance, less impairment of activity, more hope about treatment outcome, lower health care system utilization, but higher reported stress levels than non-TMD chronic pain patients. The two groups manifested no significant differences in use of narcotics, sedatives, and sleeping pills; levels of depression, anxiety, somatization, hostility, or psychoticism; illness behavior reinforcement in their social surroundings; or ratings of problems with work, family, self-esteem, or suicidal impulses.

These findings suggest that chronic TMD pain patients (with a symptom duration of over six months) are behaviorally and psychologically similar to non-TMD chronic pain patients, but that they differ in their perceptions of their disorder, rendering them less handicapped by their problems. Psychological, social, and behavioral treatment methods useful for treating chronic pain syndrome may thus also be applied along with dental therapy for optimal treatment of TMD associated with chronic pain.     

MR Spectroscopic Evidence of Brain Injury in the Non-Diagnosed Collision Sport Athlete

With growing evidence of long-term neurological damage in individuals enduring repetitive head trauma, it is critical to detect lower-level damage accumulation for the early diagnosis of injury in at-risk populations. Proton magnetic resonance spectroscopic scans of the dorsolateral prefrontal cortex and primary motor cortex were collected from high school American (gridiron) football athletes, prior to and during their competition seasons. Although no concussions were diagnosed, significant metabolic deviations from baseline and non-collision sport controls were revealed. Overall the findings indicate underlying biochemical changes, consequential to repetitive hits, which have previously gone unnoticed due to a lack of traditional neurological symptoms.     

Optimized Adenovirus-Antibody Complexes Stimulate Strong Cellular and Humoral Immune Responses against an Encoded Antigen in Na?ve Mice and Those with Preexisting Immunity

The immune response to recombinant adenoviruses is the most significant impediment to their clinical use for immunization. We test the hypothesis that specific virus-antibody combinations dictate the type of immune response generated against the adenovirus and its transgene cassette under certain physiological conditions while minimizing vector-induced toxicity. In vitro and in vivo assays were used to characterize the transduction efficiency, the T and B cell responses to the encoded transgene, and the toxicity of 1 × 10¹¹ adenovirus particles mixed with different concentrations of neutralizing antibodies. Complexes formed at concentrations of 500 to 0.05 times the 50% neutralizing dose (ND₅₀) elicited strong virus- and transgene-specific T cell responses. The 0.05-ND₅₀ formulation elicited measurable anti-transgene antibodies that were similar to those of virus alone (P = 0.07). This preparation also elicited very strong transgene-specific memory T cell responses (28.6 ± 5.2% proliferation versus 7.7 ± 1.4% for virus alone). Preexisting immunity significantly reduced all responses elicited by these formulations. Although lower concentrations (0.005 and 0.0005 ND₅₀) of antibody did not improve cellular and humoral responses in naïve animals, they did promote strong cellular (0.005 ND₅₀) and humoral (0.0005 ND₅₀) responses in mice with preexisting immunity. Some virus-antibody complexes may improve the potency of adenovirus-based vaccines in naïve individuals, while others can sway the immune response in those with preexisting immunity. Additional studies with these and other virus-antibody ratios may be useful to predict and model the type of immune responses generated against a transgene in those with different levels of exposure to adenovirus.