Facilitating the decrease in fibromyalgic pain during metabolic rehabilitation: an essential role for soft tissue therapies

Recent evidence indicates that fibromyalgia (FMS) is a manifestation of impaired metabolism. In most cases, the cause is primarily inadequate thyroid hormone regulation of cell function. The measurable features of FMS can be improved or relieved in most patients through therapy that is best termed ‘metabolic rehabilitation’. For many patients undergoing metabolic rehabilitation, however, FMS pain scores normalize only after soft tissue treatment controls or eliminates noxious neural input from the musculoskeletal system to the central nervous system. Our studies and clinical experiences convince us that effective soft tissue therapy can expedite the typical patient's improvement or recovery. Neglecting to use such therapy can hinder recovery, even when the patient undergoes expertly conducted metabolic rehabilitation. This paper describes the probable mechanisms by which musculoskeletal lesions can sustain FMS pain, and gives guidelines for treating the FMS patient's soft tissues to facilitate the reduction of pain during metabolic rehabilitation.     

Shoulder disorders—Part 2: Examination

Thorough evaluation of patients with shoulder problems should classify patients into discreet diagnostic groups—red flags, impingement syndrome, adhesive capsulitis, shoulder instability. Most rotator cuff tendonitis patients fall into the impingement category. The most important aspect of the initial evaluation is to rule out red flags suggestive of tumor, infection or fracture. If present such patients always require additional testing and often referral.A patient will be classified into the impingement category if there is (a) pain with active shoulder motions (i.e., painful arc), (b) pain with overpressure of passive shoulder elevation (i.e., a positive Neer's test) or horizontal shoulder adduction/internal rotation (Hawkins test), and (c) painfully weak resisted shoulder motions. Impingement syndrome patients should also be evaluated for partial or full-thickness rotator cuff tears, especially if the response to 4–6 weeks of rehabilitation is unsatisfactory.Patients with adhesive capsulitis have severe ROM loss. The most restricted ROMs are with shoulder abduction, external rotation, and flexion. In contrast, patients with shoulder instability are hypermobile. A history of recurrent dislocations is often present. An apprehension sign may be present. SLAP II-IV lesions are common in this patient group and the labrum can be seen to be stretched anterior during many of the functional tests.     

Clinical and radiographic evaluation of bone tumors

Timely diagnosis of osseous tumors is essential in providing proper management. Appropriate imaging studies are essential to this process, however, if inconclusive, they can be superceded by information obtained through the patient history and physical examination. Disclaimer: Dr. Bhandari's salary was provided, in part, by a scholarship from the R.K Frasier Research Foundation     

Creutzfeldt--Jakob Disease in Recipients of Human Growth Hormone in the United Kingdom: A Clinical and Radiographic Study

In the past 3 years there have been five further cases, in additionto one case reported in 1985, of Creutzfeldt-Jakob disease inrecipients of human growth hormone in the United Kingdom. Theclinical findings of two of these cases are described, demonstratinga typical presentation with a predominantly cerebellar syndromeat onset which is not commonly a presenting feature of sporadicCreutzfeldt-Jakob disease. In one case a ^99mTc hexamethylpropylenaminesingle photon emission tomographic scan showed marked impairmentof tracer uptake in the basal ganglia and cerebral cortex ata time when the clinical picture was predominantly cerebellar.This technique may be useful in early diagnosis. In the othercase post mortem examination of the brain showed prominent amyloiddeposition in the cerebellum, which has not been described previouslyin pituitary-hormone related Creutzfeldt-Jakob disease. Thepreviously published cases of growth hormone-related Creutzfeldt-Jakobdisease are reviewed and reasons for the particular clinicalpattern seen are discussed.     

番茄红素与成骨细胞、破骨细胞及骨质疏松症

学术背景:骨质疏松症是较易发生的疾病,研究骨质疏松的发病机制寻找治疗骨质疏松的药物是预防老年性骨质疏松症的理想选择。目的:综述近几年来国内外关于氧化应激及番茄红素在骨质疏松发病中的作用的相关研究,为开发预防和治疗骨质骨质疏松的药物提供理论依据。检索策略:应用计算机检索Medline和Science Direct Online数据库1989-01/2007-04期间的相关文章,检索词为"oxidative stress,osteoclast,osteoblast,lycopene,osteoporosis",限定文章语言种类为English。同时计算机检索中国期刊全文数据库2000-01/2007-04期间的相关文章,检索词为"氧化应激,骨质疏松,成骨细胞,破骨细胞,番茄红素",限定文章语言种类为中文。对资料进行初审,选择有关人体内氧化应激形成机制、氧化应激与成骨细胞、氧化应激与破骨细胞、氧化应激与抗氧化剂、番茄红素与成骨细胞及破骨细胞和番茄红素与骨质疏松症关系的最新进展文献,共收集到121篇,排除综述类及重复研究。文献评价:符合纳入标准的31篇文献中,5篇涉及骨质疏松症的概述,20篇涉及氧化应激和抗氧化剂在骨质疏松症发病中作用的相关研究,6篇涉及番茄红素与氧化应激、成骨细胞、破骨细胞及绝经后骨质疏松关系的相关研究。资料综合:氧化应激是骨质疏松发病的一个危险因素。氧化应激不但作用于成骨细胞还作用于破骨细胞。国内外学者对于番茄红素的抗氧化性能研究取得了很大进展,已通过细胞培养观察到其对成骨细胞和破骨细胞均有作用,通过临床研究发现,番茄红素通过其抗氧化功能而影响成骨细胞和破骨细胞的功能,从而能够对骨质疏松症发生发展的病理过程进行有效干预,最终阻止和减缓骨质疏松症的发生。结论:番茄红素具有的抗氧化功能使其在骨质疏松的预防及治疗方面起着重要的作用。     

Strategies to recruit plateletpheresis donors from a registry of HLA- typed, unrelated, bone marrow donors

Rising demand for single-donor platelet components–from random donors, to maintain platelet inventories, or from HLA-compatible donors, to support alloimmune platelet-refractory patients–necessitated increasing the size of a community plateletpheresis donor registry. This study compares two strategies for recruiting whole-blood donors into a plateletpheresis program. The whole-blood donors who were asked to participate in this study had recently joined an unrelated bone marrow donor registry and had been HLA-typed as part of that process. An in-person recruitment strategy, which was time-intensive for the apheresis donor coordinator, served as the standard. A by-mail strategy involved the mailing of recruitment materials to marrow-donor registry participants. Marrow-donor registry participants were approached about apheresis participation after they had indicated an interest in the plateletpheresis program by returning a tear-off section of an informational brochure that was sent to them along with their marrow- donor registry materials. A total of 852 marrow-donor registry participants were randomly assigned to one of two recruitment strategies, and the recruitment rates were the same (46%) for both methods. In addition, levels of apheresis participation and attrition rates of donors recruited by either strategy were comparable. Thus, the simple strategy of mailing information about a plateletpheresis program is a very cost-effective method of recruiting donors.