Brustwirbelsäule (BWS)

An overview of diagnostic and therapeutic methods (techniques) of manual medicine (MM)/chirotherapy in the thoracic spine region is presented. The three schools of MM of the German Society of MM describe the methods taught in seminars for physicians. The authors distinguish between common, orienting and specific diagnostics and therapeutic approaches such as mobilisation of joints and muscles and manipulative treatment. Relations to other regions are considered. Diagnostics and therapeutic approaches to the cervicothoracic region and chest will be considered in further publications.     

Interference of factor V Leiden on protein S activity: evaluation of a new prothrombin time-based assay.

Protein S activity in plasma from factor V Leiden (FVL)-positive patients may be lower than expected. We investigated a new commercially available method for protein S for such interference. Protein S activity was measured for plasmas from 50 individuals with FVL and their results were compared with those obtained for plasmas from 47 sex-matched and age-matched individuals without FVL. We assumed that the median protein S activity value from a relatively large number of individuals with or without FVL would not be significantly different if there is no influence from FVL. The FVL-positive plasmas gave relatively (albeit not significantly) lower protein S levels than FVL-negative plasmas when both were tested undiluted (86 versus 93 IU/dl, P = 0.06). Those differences were reduced (98 versus 102 IU/dl, P = 0.58) when testing was performed on diluted plasmas. Furthermore, the proportion of patients with FVL identified as low-abnormal on the basis of the specific cut-off values (undiluted = 64 U/dl; diluted = 71 IU/dl), which was 8% when testing was performed on undiluted plasmas, was reduced to 4% when testing was performed on diluted plasmas. Conversely, the corresponding proportions of patients without FVL remained unaltered (4.3 versus 4%). In conclusion, these results indicate that the evaluated method is somewhat affected by FVL and that dilution of plasma prior to testing improves specificity. Protein S activity measurement for FVL-positive patients should be performed on diluted plasma and the results interpreted on the basis of the cut-off value specifically determined for diluted plasmas.     

Electromechanical properties of perfusion/metabolism mismatch: comparison of nonfluoroscopic electroanatomic mapping with 18F-FDG PET.

The aim of this study was to compare nonfluoroscopic electroanatomic mapping (NOGA), SPECT perfusion imaging, and PET metabolic imaging for assessment of myocardial viability. In particular, we sought to elucidate differences of electromechanical properties between the perfusion/metabolism mismatch as an indicator of a potentially reversible ischemic injury and the perfusion/metabolism match indicating irreversibly damaged myocardial tissue. METHODS: Twenty-one patients with coronary artery disease underwent NOGA mapping of endocardial unipolar voltage, cardiac 18F-FDG PET of glucose utilization, and resting 201Tl SPECT of myocardial perfusion. RESULTS: Electrical activity was 10.8 +/- 4.6 mV (mean +/- SD) in normal myocardium and was unchanged in hypoperfused segments with maintained glucose metabolism (perfusion/metabolism mismatch), 9.3 +/- 3.4 mV (P = not significant). In contrast, hypoperfused segments with a perfusion/metabolism match and nonviable segments showed significantly lower voltage (6.9 +/- 3.1 mV, P < 0.0001 and 4.1 +/- 1.1 mV, P < 0.0001 vs. normal). In hypoperfused segments, metabolic activity was more closely related to endocardial voltage than was myocardial perfusion (201Tl vs. voltage: r = 0.38, SEE = 3.2, P < 0.001; 18F-FDG PET vs. voltage: r = 0.6, SEE = 2.8, P < 0.0001). CONCLUSION: In hypoperfused myocardium, electrical activity by NOGA mapping is more closely related to PET metabolic activity than to SPECT myocardial perfusion. As NOGA mapping does not differentiate hypoperfused myocardium with enhanced glucose utilization from normal myocardium, results from NOGA mapping need to be correlated with results from perfusion imaging to identify hypoperfused, yet viable, myocardium and to stratify patients for revascularization procedures.     

B(2)-receptor modulation of the reactivity to phenylephrine and angiotensin II in the carotid artery of normotensive rats after trandolapril treatment.

This study was designed to study the effects of angiotensin converting enzyme inhibitors (ACEI) following treatment with trandolapril (0.3 mg kg(-1) day(-1)) on carotid arterial responsiveness in normotensive Wistar rats. Carotid arteries were obtained from control or trandolapril-treated animals and mounted in an isolated organ bath. Reactivity to angiotensin II (Ang II), phenylephrine (Phe) and KCl was studied. Agonist concentration-response curves were constructed in either the absence or presence of the endothelium or after incubation with L-NAME (10(-6) M), HOE140 (10(-7) M) or indomethacin (10(-5) M). Trandolapril treatment decreased the Ang II and Phe potencies in carotid arteries, but did not affect the maximal response. The KCl responses (potency and Emax) were similar in both control and trandolapril-treated arteries. The absence of endothelium increased the response to both agonists in control and trandolapril-treated arteries; however, the inhibitory component from the endothelial layer of the Phe response was greater in trandolapril-treated animals than in control animals. The presence of L-NAME or HOE140 abolished the changes in the potency values of trandolapril-treated animals. The presence of indomethacin did not change the effect of trandolapril on the potency values of both agonists. We conclude that trandolapril treatment decreased the carotid arterial reactivity in normotensive rats and that this effect is endothelium-dependent. Furthermore, the involvement of B(2)-receptors and NO production, but not of prostaglandins, is suggested in this mechanism.     

Ultrasound diagnosis of hip dysplasia--current status and future perspectives]

Hip sonography provides a safe pathoanatomical assessment of a newborn hip joint at the earliest possible moment. Based on this safe diagnosis an adequate biomechanical treatment can be started instantly. The mean age of healing even of originally decentered hip joints is 7.5 months, if earliest sonographic diagnosis and adequate biomechanical treatment are performed correctly. Secondary hip surgery can be reduced to a minimum. Cost-benefit-analysis, too, supports the institution of a general sonographic screening of all newborn hip joints.     

Three-dimensional force measurements on mandibular implants supporting overdentures.

The purpose of this study was to determine masticatory and functional forces in three axes on mandibular implants supporting overdentures. Five edentulous test subjects were selected, each having two mandibular implants. Three-dimensional piezoelectric force transducers were mounted on the two-part ITI Bonefit implants and rigidly connected to the denture. Forces in vertical, lateromedial, and anteroposterior directions were measured by means of electrostatic plotter records. The test modalities were light tapping, grinding, maximal occlusal force, and chewing test food. Results showed that the five subjects developed similar stress patterns but quantitatively different occlusal and chewing forces. In all but one subject, reduced maximal occlusal force was found compared to dentate subjects and edentulous subjects with fixed partial prostheses supported by implants. The recordings of chewing cycles when eating test food resulted in very regular rhythmic strokes, similar to those of dentate subjects but with slightly reduced speed. All stress patterns showed that occlusal and chewing forces were mainly directed in vertical, medial, and anterior dimensions. The dominating component was vertical.     

Top-down and bottom-up processes in the extrastriate cortex of cirrhotic patients: an ERP study.

OBJECTIVE: This study aims to evaluate the efficiency of top-down and bottom-up processes in the extrastriate cortex of cirrhotic patients without overt hepatic encephalopathy (HE). METHODS: Reaction times (RTs), accuracy and event-related potentials (ERPs) were recorded during the execution of a visual Simon task in 17 cirrhotic patients and 10 healthy controls. Amplitude and latency of the P1 and N1 (indexes of bottom-up processes) and of the N2pc (index of top-down processes) were measured. RESULTS: Patients were slower than controls, and patients with minimal HE (MHE) were slower than patients without MHE. The distribution analysis of RTs showed that the Simon effect decays with slower RTs in all the groups and that the shape of the distribution was different in MHE patients. No differences were found between cirrhotic patients and controls for P1 and N1 amplitude and latency. In contrast, N2pc latency was delayed in cirrhotic patients compared to controls independently of MHE. CONCLUSIONS: In the extrastriate cortex of cirrhotic patients without HE, top-down processes are altered whereas bottom-up processes are preserved. SIGNIFICANCE: The analysis of exogenous and endogenous visual components of ERPs provides a model to study the functional dissociation between top-down and bottom-up processes inside the extrastriate cortex.     

Antiserotonergic inhibition of calcitonin-induced increase of β-endorphin,ACTH, and cortisol secretion

Summary In a previous study we observed that calcitonin increases -endorphin, ACTH, and cortisol secretion. We assumed that calcitonin might have a modulatory role on the pituitary function. The present study was initiated to clarify whether this effect is due to a direct pituitary stimulation or to an indirect stimulation through CRF (corticotropin releasing factor).Fourteen healthy subjects, aged 30–60 years were investigated. All the subjects received 100IU Salmon calcitonin Sandoz i.v. at 8a.m. (time 0). Plasma -endorphin, ACTH and cortisol were estimated every 30min from – 30 to 120 min by specific radioimmunoassay. The same parameters were estimated a second time, at the same intervals, when cyproheptadine 8 mg (7 subjects) and 40 mg propranolol (7 subjects) were given per os at – 30 min and calcitonin i.v. at time 0. -endorphin, ACTH and cortisol levels (Mean ±SEM) rose significantly after calcitonin (peak value at 30–90 min) from 5.2 ±0.7 to 15.1±2.6 pmol/l; from 43.0±2.7 to 70.7±4.1 pg/ml and from 10.6±1.5 to 19.6 ±2.1 g/100 ml respectively (p< 0.0001 by analysis of variance and covariance and repeated measures). Propranolol 40 mg (per os) administered at time – 30 did not alter the response of -endorphin, ACTH and cortisol to calcitonin (infused at time 0).Cyproheptadine, the antiserotonergic substance that inhibits the synthesis and release of CRF completely inhibited the stimulatory effect of calcitonin.We conclude that probably calcitonin has a modulatory role on the hypothalamo-pituitary adrenal axis and that it acts at the hypothalamic level probably by stimulating CRF secretion.     

Decrease of elastic tissue fibres in stem villus blood vessels of the human placenta during IUGR and IUGR with concomitant pre-eclampsia

In a recent study we described an increase of elastic tissue fibres in blood vessel walls of placental stem villi during pre-eclampsia when compared to uncomplicated pregnancies. Furthermore, the thickness of these blood vessel walls was enhanced in pre-eclampsia. Since it is known that elastic tissue fibres increase in systemic hypertension, it may be assumed that the enhancement of elastic tissue fibres in placental stem villi during pre-eclampsia may be induced by the hypertension. To get further insight into this assumption, we examined the amount of elastic tissue fibres in stem villus blood vessels of placentae of pregnancies complicated by intrauterine growth retardation (isolated IUGR, fourteen cases), a disease without hypertension of the mother and such with pre-eclampsia and concomitant IUGR (IUGR+PE, nine cases). Each study group was compared with uncomplicated pregnancies (twenty-six cases). Unfixed cryostat serial sections were processed for conventional orcein staining and for the demonstration of alpha-actin-immunoreactivity. The intensity of orcein staining of stem villus blood vessel walls was evaluated by a semiquantitative score method. Significant lower intensities of orcein staining were calculated for blood vessel walls of placentae of isolated IUGR (P=0.0007) and IUGR+PE (P=0.0039) when compared to uncomplicated pregnancies each. Additionally, the blood vessel wall thickness of stem villi of isolated IUGR (P=0.0081) and IUGR+PE (P=0.0007) was significantly reduced. In comparison to the above mentioned investigation, our results show that, in contrast to isolated pre-eclampsia, elastic tissue fibres are decreased during pregnancies complicated by IUGR, independently of the occurrence of concomitant pre-eclampsia when compared to uncomplicated pregnancies. From our studies it may be considered that the increase of elastic tissue fibres in placentae of patients with isolated pre-eclampsia may be induced by systemic hypertension. Furthermore, our study underline arguments that IUGR may be an independent disease of the fetus.