The biomechanics of the patellofemoral joint

Physical therapy for patella malalignment differs from therapy for other knee conditions. In fact, accepted forms of knee therapy can be counterproductive when one is dealing with patella malalignment. This article reviews some of the biomechanical foundations of patella-specific therapy and addresses common controversies. We emphasize the concept of articular cartilage stress over that of joint reaction force. The rationale for strengthening the vastus medialis obliquus and for avoiding certain forms of open chain strengthening are discussed, and we outline some of the exciting work being done in our laboratory concerning patellofemoral tracking, contact area, and cartilage properties.     

Kinematic CT of the patellofemoral joint

The relationship between time structure and procrastination was investigated among 115 Irish undergraduate students. Significant negative zero-order correlations were found among scores for all five subscales of time structure and procrastination. A follow-up stepwise multiple regression indicated a significant multiple correlation (R = .61) between all five time structure subscale scores and procrastination. Significant predictors of procrastination were scores on the Time Structure subscales of Effective Organization followed by Sense of Purpose. These results suggest that strategies focusing on time management in conjunction with existential approaches of psychotherapy may be an effective intervention for reducing procrastination.     

A multimodal approach in the diagnosis of patients with hematopoietic disorders

We previously reported that ethanol elicits an increased protein oxidation in the liver of rats receiving chronic ethanol by continuous intragastric infusion (Tsukamoto-French method). This accumulation of oxidized proteins could result from a decrease in the cytosolic proteolysis, related specifically to alkaline protease and its major components, the proteasomes. Because several studies suggest that intracellular proteolysis depends on the severity of oxidative stress, we investigated the cytosolic proteolytic activity under two chronic ethanol treatment paradigms associated with varying degrees of oxidative stress. For 4 weeks, male rats received chronic ethanol by continuous intragastric infusion or by oral administration (10% ethanol ad libitum as sole drinking fluid). A significant decrease was evident for alkaline protease activity as well as for sodium dodecyl sulfate (SDS)-activated latent 20S proteasome (chymotrypsine-like [ChT-L] and peptidylglutamyl peptide hydrolase [PGPH] activities) in the liver of rats receiving ethanol by continuous intragastric infusion. Free radical production and related processes appeared to be contributing events in proteolysis inhibition, because phenethyl isothiocyanate (PIC), an inhibitor of cytochrome P4502E1 (CYP2E1), reduced the inhibition of the ethanol-related ChT-L activity. Moreover, the lipid peroxidation level was inversely correlated with ChT-L activity. In contrast, no such changes were observed in ChT-L and PGPH activities or in cellular free radical targets following the oral ad libitum consumption of 10% ethanol. It appears, thus, that only the alcohol treatment paradigm associated with an overt oxidative stress produced a significant inhibition of the proteasome activity. The mechanisms of proteasome inhibition could involve the formation of an endogenous inhibitor such as protein aggregates or aldehyde-derivative peptides. Whatever the mechanism, the inhibition of cytosolic proteolysis and the subsequent accumulation of damaged proteins may be involved in the oxidatively challenged alcoholic livers and play a pathogenic role in experimental alcoholic liver disease.     

Experimental evaluation of theoretical contact forces in the cat patellofemoral joint

The purpose of this study was to evaluate the accuracy of patellofemoral contact forces predicted from a planar model of the patella by comparison with experimentally determined in situ contact forces. Patellofemoral contact pressures and areas were measured experimentally in an animal preparation with pressure sensitive film. Patellar tendon forces and lines of action used as input to the model were measured in the intact joint of the same preparation. Predicted and measured contact forces at different joint loads were compared at three different joint angles using linear regression analysis. r2-coefficients ranged from 0.94 to 0.95, and the slopes of the regression lines ranged from 1.64 to 2.11 for the three joint angles. The high r2-coefficients for all comparisons indicate that both methods were able to quantify the relative changes in the cat patellofemoral contact forces under different loading conditions accurately. However, the consistent finding of slopes greater than 1.0 indicates that the measured contact forces were systematically larger than the corresponding predicted forces. Analysis of the possible sources for the observed discrepancies between predicted and measured contact forces suggested that the directly measured patellar tendon forces were the most likely candidate causing the systematic differences. The results of this study suggest that a relatively simple model of the patellofemoral joint appears to be valid to quantify joint contact forces if appropriate patellar tendon force values can be provided as input to the model.     

Differential prevalence of cigarette smoking in patients with schizophrenic vs mood disorders

Reactive oxygen species (ROS) and reactive metabolic intermediates generated from various chemical carcinogens are known to play an important role in cell damage and in the initiation and progression of carcinogenesis. Many radical scavengers, interestingly naturally occuring antioxidants have been found to be effective in inhibiting the induction of carcinogenesis by a wide variety of chemical carcinogens. Studies have also indicated that various spice principles form an important group as antioxidants. In the present study our goal was to investigate whether piperine an pungent principle of black and long peppers was able to inhibit or reduce the oxidative changes induced by chemical carcinogens in rat intestinal model. Carcinogenesis was initiated in intestinal lumen of male rats with 7,12,dimethyl benzanthracene, dimethyl amino-methyl azobenzene and 3-methyl cholenthrene. Oxidative alterations were assessed by determining thiobarbituric reactive substances, mainly malonaldehyde (as a measure of lipid peroxidation), thiol status and expression of gamma-GT and Na+-K+-ATPase activity in intestinal mucosa. Data indicated that carcinogens treatment induced GSH depletion with substantial increase in thiobarbituric reactive substances and enzyme activities. Piperine treatment with carcinogens resulted in inhibition of thiobarbituric reactive substances. It mediated a significant increase in the GSH levels and restoration in gamma-GT and Na+-K+-ATPase activity. The studies thus indicate a protective role of piperine against the oxidative alterations by carcinogens. It may be suggested that piperine modulates the oxidative changes by inhibiting lipid peroxidation and mediating enhanced synthesis or transport of GSH thereby replenishing thiol redox.     

Importance of use of ultrasound in the early diagnosis and treatment of hip joint developmental disorders

Developmental dysplasia of the hip has been a problem for over a thousand years. Clinical signs are insufficient for an exact diagnosis, X-ray diagnosis is reliable only at the age of six months and later. Advantages of ultrasound diagnosis (used immediately after birth), classification of findings and basic treatment are described.     

Temporomandibular joint disorders and surgery of the temporomandibular joint

Surgery of the TMJ is a useful tool in Temporo Mandibular Disorders (TMD). After have been identified what is part of TMD and what isn't, this article lay stress upon the fact that surgery of the TMJ is the appropriate treatment only when the nonsurgically therapy had failed. Indications, danger and complications are discussed. Procedures of arthrotomy and arthroscopy are explained. Various surgical procedures and staging of TMD are discussed.     

Differential diagnosis of attention deficit and conduct disorders using conditional probabilities.

Attention deficit and conduct disorders require an important yet often difficult differential diagnosis. Prior efforts to determine which symptoms are optimal for making this differential diagnosis have been limited by a reliance on statistics that do not supply the probability of the disorders given a symptom's presence (positive predictive power) or the probability that the disorder is not present given the absence of the symptom (negative predictive power). This investigation examined the utility of these latter statistics in the differential diagnosis of childhood attention deficit and conduct disorders. The data consisted of symptoms from a standardized maternal psychiatric interview collected for a sample of 76 clinic-referred boys. Results indicated that some symptoms are optimal as inclusion criteria, some as exclusion criteria, some as neither, and some as both. Furthermore, some symptoms that have been traditionally associated with the diagnosis of one disorder were actually found to be more useful in the diagnosis of the other disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorders in patients with eating disorders in Japan

The use of a mnemonic cueing system (NeuroPage) and a paper and pencil checklist in the rehabilitation of executive problems in a 50-year-old woman are described. Following a CVA 7 years earlier, the patient, despite intact general intellectual and memory functioning, had specific executive impairments of attention, planning, realizing intended actions, and also exhibited behavioral routines similar in form to obsessive-compulsive rituals. In a series of ABAB single-case experimental designs, the efficacy of 2 external cueing systems in prompting appropriately timed action is demonstrated. It is argued that the combination of external control and increased sustained attention to action were critical to the success of NeuroPage with this patient. Furthermore it is hypothesized that the checklist was effective in facilitating the patient's ability to foresee and recognize the consequences of her actions, which in turn had an impact on the probability of her changing those same actions.     

Incidence of temporomandibular joint disorders in patients seen at a hospital emergency room

A retrospective survey of a hospital emergency room population seen at an oral and maxillofacial surgery clinic during a 6-month period found 62 patients (2.7% of the total population) with temporomandibular joint disorders. The diagnoses were myofascial pain-dysfunction/temporomandibular joint dysfunction (MPD/TMJ) syndrome (70.9% of the cases) and dislocation (luxation) (22.5% of the cases). The chief complaint was well defined in relation to the diagnoses: facial pain in the MPD/TMJ syndrome cases, and displacement of the mandible in the dislocation cases.     

Functional state of the masticatory system in healthy individuals (control group) and in patients with temporomandibular joint disorders

The functional status of the masticatory system was investigated in a sample of 68 self-defined controls without any treatment need and 82 craniomandibular disorder patients. Among the parameters investigated were measures of mandibular mobility, the presence of joint noises and palpation tenderness of 17 muscle and 3 TMJ sites. These data allowed for calculation of Fricton's Craniomandibular Index (CMI) and Helkimo's Clinical Dysfunction Index (Di). Several socalled signs of dysfunction were found in the normal control group: 38% of the joints had some kind of noise and several muscle sites were tender to palpation (splenius capitis muscle 50%, anterior masseter and temporal muscle 45%, insertion of the trapezius muscle 40%). In addition, according to Helkimo's Di. 90% of the controls would be classified as having mild to moderate dysfunction. The high prevalence of positive signs in the control sample calls for a less rigid definition of what is called a normal craniomandibular status and refutes the a priori establishment of a narrow set of criteria for normality. Some parameters showed a highly statistically significant difference among the control and patient group (p < .001): active range of motion, deviation upon opening, pain on mandibular movement, number of tender palpation points and the CMI and Di.     

Differential osteoporosis diagnosis in the woman

Bone mineral density of a woman in the second half of her life depends on the amount of bone made during growth and its subsequent rate of loss. Although the rate of bone loss did receive more attention in the study of pathogenesis of osteoporosis, it is becoming increasingly clear that insufficient accumulation of skeletal mass by young adulthood predisposes a person to low bone mass and subsequently to fractures later in life as age related and menopause-related bone loss ensue. In this article we 1) explain the role of inadequate peak bone mass as a major risk factor for osteoporosis and 2) give an overview of factors leading to osteoporosis by decreasing bone mass. Special emphasis has been put on iatrogenic osteoporosis which is frequently neglected because of the fact that the responsible agents often are not known as to be deleterious to the skeleton: among others, glucocorticoids, thyroid hormones and antiepileptics adversely affect bone.     

The intraoperative diagnosis of functional disorders of the major duodenal papilla in patients with acute biliary pancreatitis]

Tertian malaria is endemic in south-eastern Anatolia. As in Europe and America, in south-eastern Anatolia, an etiological agent is seldom identified in nephrotic syndrome. Two patients with Plasmodium vivax and nephrotic syndrome are described here. The possible relationship between Plasmodium vivax and nephrotic syndrome should be explored in children in endemic malarial regions.     

Differential diagnosis in dementia

The results of an autopsy of a 78-year-old female patient with an occluded of the right internal carotid artery after a traffic accident are reported. She presented with consciousness disturbance, right conjugate deviation, left hemiparesis and left pathological reflex. Evidence of right skull and clavicular fractures seemed to suggest that severe hyperextension of her neck associated with contralateral lateral flexion had stretched her carotid artery. Although she was treated with antiplatelet therapy, her cerebral swelling due to right global infarction progressed and she died due to bilateral cerebral herniation three days after injury. The autopsy disclosed right dissecting carotid artery occlusion and subadventitial dissection was revealed histologically. When a hematoma dissect the media and adventitia of the carotid artery wall, the outer wall weakens and may dilate without narrowing the lumen of the carotid artery. In this case, the vessel occlusion was considered to be due to a primary intramural hematoma which developed and subsequently ruptured through the intima into the vessel lumen. Early diagnosis and treatment are necessary for improving the prognosis of this disease entity. A patient with poor colateral flow, such as in this case, will show a rapid progression of cerebral infarction. It is best to consider surgical treatment in this case if the other traumatic lesions are able to tolerate surgery.     

Motility disorders of the esophagus--their diagnosis with a rice-barium meal

The purpose of this study was to evaluate the role of a "barium-rice" study for diagnosis of dysphagia and oesophageal motility disorders. MATERIAL AND METHODS: 203 patients with oesophageal motility disorders of various aetiologies were examined by both conventional barium study and a "barium-rice" study. During the latter, oesophageal clearance of a defined mixture of barium sulfate and boiled rice was measured. RESULTS: The conventional barium study revealed prolonged transit time in only 15.8% (32 of 203 cases), whereas barium-rice study was pathological in 50.8% (103 to 203 cases). In 71 of 171 patients (41.5%) with a normal barium study, barium-rice passage was prolonged. In 23 patients, radiological results were confirmed by manometric measurements. CONCLUSION: Oesophageal motility disorders are detected by a barium-rice study with high sensitivity independent of the underlying disease. The barium-rice study offers a simple diagnostic tool revealing quantitative and reliable results. The barium-rice study is a suitable method for screening and follow-up of patients with dysphagia and oesophageal motility disorders.     

Motility disorders of the esophagus: diagnosis with barium-rice administration

PURPOSE: To evaluate the role of barium-rice administration for a standardized diagnosis of dysphagia and esophageal motility disorders. MATERIALS AND METHODS: Sixty healthy volunteers and 218 patients with various esophageal disorders (achalasia, scleroderma and other connective tissue diseases, neurologic diseases, esophagitis and others) were examined both by a conventional barium study and by a barium-rice study. The barium-rice meal consisted of barium sulfate and boiled rice, mixed half and half. The time required for esophageal clearance of one sip was measured. RESULTS: Normal esophageal transit time in healthy controls was between 5 and 15 s for both methods. In patients, the conventional barium study revealed a prolonged transit time in only 16.5% (36 of the 218 cases). The barium-rice study was abnormal in 51.8% (113 of 218 cases), independent of the underlying disease. The barium-rice study was pathological in 77 of those 182 patients (42.3%) who had normal barium transit time. In 24 patients the radiologic results was confirmed by endoscopy and manometric measurements. CONCLUSIONS: Esophageal motility abnormalities are detected by a barium-rice study with a high sensitivity. With this simple and low-cost method, quantitative and reproducible results can be obtained. Barium-rice administration is a suitable tool for screening and follow-up of patients with dysphagia and esophageal motility disorders.