Subjective assessment of temporomandibular joint sounds

This study was performed to evaluate whether beta-blocker therapy was effective in patients with nonischemic dilated cardiomyopathy (DCM) and bradyarrhythmias supported by pacemaker implantation. Beta-blocker therapy is useful for some patients with DCM, especially those with rapid heart rate or residual nonfibrotic myocardium in the left ventricle, but no data exist on whether beta-blocker therapy is useful in patients with DCM and bradyarrhythmias. The effectiveness of beta-blocker therapy was prospectively evaluated in patients with DCM and bradyarrhythmias supported by pacemaker implantation and compared with those without these arrhythmias. Beta-blocker therapy was started in 63 patients (45 men, 18 women, aged 11-83 years) with DCM, in whom 7 had bradyarrhythmias and 56 did not. These bradyarrhythmias were atrioventricular block, sick sinus syndrome and atrial fibrillation with slow heart rate. Of the 56 patients without bradyarrhythmias, 42 (75%) (group 1) responded to beta-blocker therapy, but 5 of the 7 with bradyarrhythmias (71%) (group 2) also responded. Left ventricular end-diastolic dimension was reduced (6.5 +/- 0.6 cm to 5.6 +/- 0.5 cm; p < 0.0001 in group 1; 6.6 +/- 0.8 cm to 5.5 +/- 0.2 cm; p < 0.02 in group 2) and left ventricular fractional shortening was improved (13 +/- 4% to 27 +/- 7%; p < 0.0001 in group 1; 12 +/- 4% to 29 +/- 10%; p < 0.05, in group 2) to the same degree in both groups. These results indicate that beta-blocker therapy for DCM is effective not only in patients without bradyarrhythmias but also in those with bradyarrhythmias supported with pacemaker implantation.     

Electronic thermography for the assessment of acute temporomandibular joint pain

Electronic thermography (ET) has the potential to be a nonionizing, noninvasive, low-cost diagnostic alternative for evaluating temporomandibular joint (TMJ) disorders. This study was designed to evaluate the use of ET as a diagnostic aid in the assessment of patients with acute TMJ pain. Computer measurements made using facial thermography were able to distinguish normal patient populations from symptomatic patients with acute TMJ pain. Additional studies are needed before thermographic diagnosis of TMJ disorders will be clinically accepted.     

Stress analysis of the human temporomandibular joint

OBJECTIVE: To examine how dietary intake varies with age in a nation-wide sample of adult Norwegian women, and to evaluate the impact of lifestyle and socio-economic status on important dietary aspects. DESIGN: Cross-section study. SETTING AND SUBJECTS: A food frequency questionnaire was mailed to a random, nation-wide sample of 20 000 women aged 45-69y, and 9885 questionnaires were accepted for nutritional analyses. RESULTS: Dietary habits differed moderately with age. The oldest women reported a higher consumption of potatoes and fish, whereas the youngest reported more coffee, meat, and alcohol. The reported intake of fruit, vegetables, and potatoes was lower than recommended in all age groups. Older women had a slightly better distribution of energy yielding nutrients than younger women, although the median percentage of energy from fat was too high in all age groups. The median dietary fibre density of the diet was close to the recommended level in all age groups, yet lowest among the youngest women. Practising a healthy lifestyle and having a higher socio-economic status were associated with reporting a healthier diet. However, adjusting for lifestyle and socio-economic factors did not substantially alter the associations between diet and age. CONCLUSIONS: Older women tend to have a healthier diet than younger women. The relationship does not seem to be strongly confounded by lifestyle and socio-economic status, although these factors are also related to dietary habits.     

Bone demarcation of the temporomandibular joint. Validity of clinical assessment of bone thickness by means of CT

OBJECTIVE: To study the effect of induced hypoglycaemia on serum levels of the placental hormones oestriol, human placental lactogen, placental growth hormone and progesterone in the third trimester of pregnancy. DESIGN: A prospective experimental investigation. SETTING: High risk pregnancy unit and diabetes research unit at Karolinska Institutet Danderyd Hospital, a university hospital. PARTICIPANTS: Ten women with insulin-dependent diabetes mellitus in the third trimester of pregnancy. METHODS: Venous blood samples were collected every 15 minutes for analyses of oestriol, progesterone, human placental lactogen and placental growth hormone, during the 150 min of a hyperinsulinaemic hypoglycaemic clamp, which maintained arterial blood-glucose level of about 2.2 mmol/l. MAIN OUTCOME MEASURES: Levels of analysed placental hormones during hypoglycaemia. RESULTS: A statistically significant increase was observed in placental growth hormone during hypoglycaemia (P < 0.0001), whereas the placental hormones progesterone, human placental lactogen and oestriol did not show changes of clinical significance. CONCLUSIONS: The increase in placental growth hormone indicates that the placenta is an endocrine organ which may take an active part in acute metabolic processes, such as here in the hormonal counterregulation of hypoglycaemia.     

Evidence for selective use of bone scans in early stage breast cancer

To determine the usefulness of bone scans in detecting metastatic disease in women with early stage breast cancer, records of 193 patients who had bone scans preformed and underwent breast conservation therapy at a single institution were reviewed. Patients with invasive T1 or T2 breast carcinomas were eligible for this study; patients with a true positive bone scan were excluded from conservation therapy and, thus, were excluded from this study. The incidence of false positive bone scans in this study population was 32.6% (63/193 patients). Patients over 50 years of age had a significantly greater incidence of false positive bone scans (p<0. 05). In the 63 patients with false positive bone scans, 101 radiographs were performed to exclude metastatic disease in areas of increased uptake identified on bone scan. No significant difference in the rate of false positive bone scans was seen in relation to tumor size, pathologic or clinical nodal status or hormone receptor activity of the primary tumor. Thus, selective use of bone scans is advocated in patients with early stage (T1 or T2) breast cancer.     

Interobserver reliability in quantitative MRI assessment of temporomandibular joint disk status

OBJECTIVE: The purpose of this study was to investigate interobserver reliability of a new technique for quantification of magnetic resonance images of temporomandibular joint disk status. STUDY DESIGN: Sixty magnetic resonance images of adolescent temporomandibular joints were randomly drawn for analysis. Four experienced observers traced the articular disk and osseous structures on sagittal magnetic resonance slice images. Quantitative measurements of disk length and disk displacement were recorded for each slice of 57 joints traced by each observer through use of a new quantification technique. Intraclass correlation coefficients were computed to assess interobserver agreement in the tracing of joint structures. RESULTS: The calculated intraclass correlation coefficient was 0.681 for disk length and 0.830 for disk displacement. In addition, the mean variability among observers was 1.041 mm for measurement of disk length and 0.972 mm for measurement of disk displacement. CONCLUSIONS: Interobserver agreement is high when the new quantification technique is used to interpret magnetic resonance images.     

The classification of diseases of the temporomandibular joint

There were 2040 patients with temporomandibular joint (TMJ) diseases in the investigation including clinical, physiological, X-ray methods of research, contrast arthrotomography, computer arthrotomography and magnetic resonance tomography. The changes of structure in different lesions were estimated. The result of received data was elaboration of classification of TMJ internal derangements with estimation of clinical forms in according with structural changes and characteristics of syndromes.     

The medial capsule of the human temporomandibular joint

PURPOSE: Attachments of the medial capsule of the temporomandibular joint (TMJ) to structures other than the medial fossa wall are thought to exist and to have functional significance. This study evaluated these relationships. MATERIALS AND METHODS: The anatomic relationships between the medial capsule and other medial structures, the sphenomandibular ligament, discomalleolar ligament, and auriculotemporal nerve, were examined in 14 cadaver heads. RESULTS: The results showed that the sphenomandibular ligament attaches separately from the medial capsule of the TMJ and therefore has no functional significance to the biomechanics of the joint. The discomalleolar ligament was found to be a continuation of the retrodiscal tissues and minimally associated with the medial capsule. The auriculotemporal nerve was not found to be in a relationship with the medial aspect of the condyle to the extent that mechanical irritation is possible during TMJ movement or disc displacement.     

The analysis of radioisotope brain scans by comparison with normal patterns of uptake

A previously described method for the computer analysis of radioisotope brain scans has been further developed. A patient scan is matched with a series of "normal" scans to find the closest fit and the "normal" scan is then subtracted from the patient scan. The results are displayed in terms of the standard deviation from the normal. In a clinical trial the computer assessments were found to be less accurate than those of two groups of observers. One reason for these disappointing results is related to the simple criteria used to choose and fit the best "normal" to a particular patient scan. A second reason is the optimization of the scanner/photoscan combination to 99Tcm pertechnetate as a brain scanning agent which results in patient-to-patient variation becoming more important. This reduces the potential of a simple numerical analysis to improve results.     

The use of quantitative bacteriologic assessment of bone

A new sub-class of binding protein-dependent transporter with specificity for a broad range of polar amino acids has been identified by sequence comparison, in Rhizobium leguminosarum, Rhodobacter capsulatus, Escherichia coli and Pseudomonas fluorescens. Southern blotting and PCR analysis has shown that transporters from this new sub-class are widely distributed in Gram-negative bacteria, including, in addition to the above, Citrobacter freundii, Erwinia carotovorum and Rhizobium meliloti. ABC transporters of polar amino acids can be divided into two groups: those with narrow solute specificity and the newly identified sub-class with broad solute specificity. The binding and inner membrane proteins from transporters with a broad solute specificity are larger by approximately 30% than those with a narrow solute specificity. Multiple alignment of the inner membrane proteins from all sequenced polar amino acid transporters indicates there is an N-terminal conserved region that may be involved in solute specificity. A conserved arginine or lysine at residue 30 of this region is changed to glutamate in arginine transporters. Residue 53 also has a strong correlation with the charge on the transported solute, with basic amino acid transporters replacing an aliphatic amino acid at this position with a negatively charged amino acid. The general amino acid permease from R. leguminosarum, which will transport aliphatic as well as basic and acidic amino acids, juxtaposes two prolines at residues 52 and 53 of the N-terminal conserved region.     

The role of bruxism in the appearance of temporomandibular joint disorders

Bruxism is a parafunction observed both in young and adult populations. The mean prevalence is about 20% and is decreasing with age. Women appear to clench more frequently than men. Often, bruxism is understood as both clenching with occasional tooth contact or grinding. A correct and validated definition has only recently been suggested. Many symptoms are assigned to this process, although few symptoms scientifically can be used as specific diagnostic criteria. The symptoms most often associated with bruxism like muscle-stiffness and -pain, limitation of mouth opening. TMJ-internal derangements, toothwear, are also found in TMD-patients. Because the bruxism-process is not only a problem for the patient, who suffers from pain, dysfunction and possible toothwear, it concerns also the dentist. It is essential that those who treat the bruxist-patient, have an understanding of the etiology, diagnosis and management of bruxism, of the many described oral parafunctional behaviors (oromotor behavior). This literature-review could not find a causal etiological mechanism between the occurrence of TMD-symptoms and the bruxism although a relationship between those two conditions has been described.     

Laser arthroscopy of the temporomandibular joint

Laser surgery is very different than traditional surgery. The clinician must be familiar with the physical properties of the laser to use this instrument safely and properly. Various lasers are available for use in oral and maxillofacial surgery and dentistry, namely the carbon dioxide laser, the neodymium:yttrium-aluminum-garnet laser, and the holmium: yttrium-aluminum-garnet laser (Ho:YAG). Only the Ho:YAG laser has been used with effectiveness in temporomandibular joint arthroscopic surgery.     

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.     

Focal areas of increased renal tracer uptake on bone scans can mimic metastases in the lower ribs

Focal renal concentration of radioactivity can simulate metastatic deposits in the lower ribs on bone scintigrams. 400 consecutive bone scintigrams were reviewed for focal areas of increased tracer activity in the kidneys. 62 patients (15.5%) had at least one renal hot spot. In 42 of these 62 patients (67.7%) there was an increased focal uptake in the left kidney (18 upper pole, 18 middle pole and six lower pole). 50 out of 62 bone scans (80.7%) showed increased activity in the right kidney (14 upper pole, 32 middle pole and four lower pole). With the incidence of focal areas of activity in the upper poles of the kidneys being 8%, the interpretation of a single focal abnormality projected over the lower ribs should be made with particular care, especially in cancer patients.     

Comparison of reticuloendothelial scans with bone scans in malignant disease

Thirty patients with histologically proven malignant disease were selected for reticuloendothelial scans and bone scans because of suspected bone or bone marrow involvement. Reticuloendothelial scans were abnormal in 83% of the patients and bone scans were abnormal in 47%. Focal defects on the reticuloendothelial marrow scan correlated better with tumor infiltration of the marrow than did diffusely abnormal scans. Focal defects were found in nine patients (30% of total), four of whom had negative or equivocal bone scans. In multiple myeloma, reticuloendothelial marrow scans were more sensitive than bone scans, but were not clearly better than bone scans in patients with solid tumors. In the interpretation of reticuloendothelial scans, consideration must be given to the effects of radiation, chemotherapy, and uremia, all of which may cause decreased reticuloendothelial uptake and falsely positive reticuloendothelial scans. Reticuloendothelial scans seem most useful for hematologic malignancies that have not been previously treated. The advantages and disadvantages of reticuloendothelial scans are discussed.     

The cerebrovascular manifestations of temporomandibular joint pain dysfunction

Overall 37 patients with painful dysfunction of the temporomandibular joint (TMJ), characterized clinically by headaches and dizziness as well (25 persons) were examined. A study was made of REG. The responsiveness of the sinocarotid node (SCN) was recorded. Diverse changes in the REG readings that attested to the development of cerebral angiodystonia were recorded. Abnormal responsiveness of SCN was discovered. Skillful orthopedic correction of the spatial position of the mandible was associated with noticeable changes in the normalizing and optimizing character of numerous REG readings. These data together with optimization of the responsiveness of the SCN point to the role played by the irritative vascular mechanism in the pathogenesis of headaches and dizziness seen in TMJ dysfunction.     

Evaluation of the temporomandibular joint in panoramic radiography

It was shown that a single intraperitoneal administration of Bacillus intermedius RNAse to rats stimulated the activity of lysozyme and blood serum complement. A single intraperitoneal administration of pancreatic RNAse, Bacillus intermedius RNAse and its derivative selectively inactivated by the histidine active centre stimulated the metabolic activation of neutrophils as was shown by their ability to reduce tetrazolium nitroblue to diphormazone. The efficiency of the neutrophil stimulation by the RNAses was comparable with that of the microbial vaccine and did not depend on the catalytic activity of the RNAses.