Diagnosing TMJ internal derangement and osteoarthritis with magnetic resonance imaging.

BACKGROUND: The authors conducted a study to investigate the relationship between the presence of temporomandibular joint, or TMJ, pain and magnetic resonance imaging, or MRI, findings of internal derangement, or ID, and arthritis, or OA. METHODS: The authors studied 131 consecutively seen TMJ pain patients. Their criteria for including a patient in the study were report of unilateral orofacial pain referred to TMJ and the presence of unilateral TMJ pain during palpation, function, and unassisted or assisted mandibular opening. The authors took bilateral sagittal and coronal MRIs to establish the presence or absence of TMJ ID, OA or both. RESULTS: When the authors compared TMJ side-related data from all subjects, they found a significant relationship between the clinical findings of TMJ pain and the MRI diagnoses of TMJ ID (P = .000) and TMJ OA (P = .013). They also found a significant relationship between the MRI diagnosis of TMJ ID type and that of TMJ OA (P = .000). The authors used the kappa statistical test and found poor diagnostic agreement between the presence of TMJ pain and the MRI diagnosis of TMJ ID (kappa = 0.21), TMJ OA (kappa = 0.15), and TMJ ID and OA combined (kappa = 0.18). CONCLUSIONS: The study's findings suggest that while clinical pain is related to TMJ-related MRI findings, the presence of clinical pain is not a reliable predictor of TMJ ID, OA or both. CLINICAL IMPLICATIONS: Using MRI to supplement clinical findings of TMJ pain appears warranted and necessary to establish the presence or absence of TMJ ID.

Bilateral investigation of the temporomandibular joint. An autopsy study of edentulous individuals.

Investigations concerning normal and pathological anatomy of the temporomandibular joint (TMJ) have shown that pathological reactions such as deviations of the shape of the condyle, disc thinnings, disc perforations and osteoarthrotic changes are fairly common, particularly in the elderly population. Autopsy studies of the TMJ describe pathological findings respective to their location in different age groups, but most authors describe their findings for removed joints of one side only. The specific aim of this study was therefore to investigate the intra-individual relationships between the degenerative changes and deviations concerning the articular surfaces of the TMJs and the topographical distributions of these findings. In this investigation both joints of 22 edentulous individuals between 58 and 95 years of age were studied. Correlations were found between the right and left joints with respect to the anatomical location of the pathological findings.

Quantitative analysis of masseter and temporalis EMGs: a comparison of anterior guided versus balanced occlusal concepts in patients wearing complete dentures.

The lack of easily measurable, objective physiological activity parameters of the masseter and temporalis muscle during jaw movements in humans has led to the consideration to revise data of surface electromyographies (EMGs) by applying a computerized quantification method. The aim of this follow-up analysis was to get quantitative data out of EMG-records of an earlier study. These records were obtained with two different splints, splint 1 providing an anterior front-canine guidance and splint 2 providing bilateral balanced occlusion. Utilizing a computer aided integration method led to numeric results which statistically proves the prediction of the previous investigation. Applying the integration method, the EMG raw signal was transformed into area-values which enabled a statistical work up of the data. Wilcoxon test statistics shows a significant (P<0.05) lower muscle activity in patients wearing dentures providing anterior front-canine guidance compared to those with balanced occlusion. It is concluded that the neuromuscular activity of the elevator muscles is highly reproducible and that the neuromuscular function is similar in edentulous subjects to that found in people with natural teeth. Furthermore, the study statistically proves earlier visual data that all those subjects, whose muscle activities were observed with anterior guidance (splint 1) compared to bilateral balanced occlusion (splint 2) showed significantly lower values with regard to subjects wearing splint 2.

Cerebral blood flow velocity and perfusion in purulent meningitis: a comparative TCD and 99M-TC-HMPAO-SPECT study.

In 15 patients (median age 33 years; range 17-74 years) suffering from acute pneumococcal (10 cases) and meningococcal (five cases) meningitis, cerebral blood flow velocity (CBFV) was measured in the M1 - segment of the middle cerebral artery (MCA) by transcranial Doppler sonography, and cerebral perfusion changes were evaluated by 99m-Tc-hexamethylpropylene amine oxime single photon emission computed tomography (HMPAO SPECT). The objective of the study was to test whether increased CBFV during the acute phase of purulent meningitis reflects hyperemia, and to evaluate focal perfusion abnormalities and their correlation to CBFV changes. In eight patients with marked side-differences in CBFVs during the acute phase of the disease SPECT scans were normal in five. In three patients unilateral perfusion defects correlated with the side of higher CBFV. In seven patients presenting with symmetrically elevated CBFV, SPECT scans were normal in four and revealed focal abnormalities in the remaining three. Follow up SPECT scans were normal in 14/15 patients. The results of our study suggest that elevated CBFV in acute bacterial meningitis does not reflect cerebral hyperemia. Focal cerebral perfusion defects occur independently from functional alterations in the cerebral macrovasculature. A causative pathophysiologic relationship of high CBFV and focal perfusion defects cannot be drawn from these data.

[Multimodal therapy of Miller-Fisher syndrome. Possible benefit of cerebrospinal fluid filtration]. / Multimodale Therapie eines Miller-Fisher-Syndroms. Der mögliche Nutzen der Liquor-cerebrospinalis-Filtration.

A 47 year old male patient with Miller-Fisher-syndrome did not respond to treatment with plasmapheresis and intravenous high dose 7 S immune globulins. Only cerebrospinal fluid pheresis, administered as final alternative, lead to definite improvement and cure.

Multimodal therapy in life-threatening cerebral lupus erythematosus: the benefit of cerebrospinal fluid pheresis.

A 27-year-old female patient with severe cerebral systemic lupus erythematosus did not respond to conventional therapy, including high-dose corticosteroids and high-dose pulsed cyclophosphamide therapy. Cerebrospinal fluid filtration (pheresis) led to rapid and lasting neurological improvement and clinical cure.

Control of Ia afferent input to triceps surae (soleus) locomotor nucleus precedes agonist muscle activation during gait.

Modulation of the triceps surae (soleus) H-reflex was investigated during treadmill walking to elucidate the temporal relationship between reflex facilitation and initiation of agonist muscle activation. Constant effective stimulation of the tibial nerve evoked the H-reflex. Contact foot switches monitored phases of the gait cycle. H-reflex changes were assessed at predetermined intervals across a window that anticipated the onset of soleus muscle electromyographic (EMG) activation. In five of six healthy subjects, multiphase statistical models revealed a 'breakpoint', reflecting a significant rise in H-reflex amplitude, beginning with stimuli delivered 144.1, 142.9, 148.8, 186.4 and 140.5 ms, respectively, prior to mean onset of EMG activity in the soleus muscle. In the sixth subject, no breakpoint was identified although the H-reflex amplitude gradually increased across the analysis window. These findings suggest that facilitation of the H-reflex is established well in advance of the descending corticomotoneuronal command to recruit spinal motoneurons in the motor act (i.e. prior to threshold spinal motoneuron depolarization). It is argued that a central programme controlling afferent input to the locomotor nuclei is part of the 'preparatory set' which precedes execution of the motor act.

Cerebrospinal fluid-filtration reduces TNF alpha in bacterial meningitis-CSF.

A 37 year old male was admitted with the diagnosis of bacterial meningitis. Pneumococci were seen in the Gram stain of the cerebrospinal fluid. The clinical condition did not suggest severely raised intracranial pressure, there were no localizing signs and symptoms. CSF was turpid, with 20.100/3/mm(3) , mainly polymorphonuclear cells. Tumor necrosis factor alpha in CSp was greatly increased with 813 pg/ml. Parallel to the application of intravenous Penicillin G a CSF filtration was carried out. Within 214 h 225 ml CSF were filtrated through a Pall-filter, using a bidirectional pump. Cell count dropped to 720/3 cells/mm(3) , TNF-alpha to 39 pg/ml. The clinical course was uneventful, on day 12 the patient could be discharged without sequelae. CSF filtration may be a highly effective method to reduce from the CSF pathogenetically important cytokines, such as TNF-alpha, being responsible for intrathecal/meningeal inflammatory processes and triggered by cell-wall components of bacteria, e.g. pneumococci.

[Neurologic manifestations of diabetes mellitus: an overview]. / Neurologische Manifestationen des Diabetes mellitus: ein Uberblick.

Neurological manifestations of diabetes mellitus comprise structural changes in both central and peripheral nervous system, as well as functional cerebral disturbances. Macro- and microangiopathy are responsible for the development of cerebrovascular diseases; microangiopathic and metabolic disturbances are considered in the discussion to be responsible for the development of the various forms of diabetic polyneuropathy. Acute metabolic episodes with progressive impairment of consciousness have to be differentiated from structural neurological disorders. As a further point of interest the association between diabetes mellitus and special neurological diseases is mentioned.

Effect of the inhibitory phenomenon following magnetic stimulation of cortex on brainstem motor neuron excitability and on the cortical control of brainstem reflexes.

We studied the effect of the inhibitory phenomenon following transcranial magnetic stimulation (TMS) on brainstem motor neuron excitability and on the cortical control of brainstem reflexes in 5 normal subjects. The R1 component of the blink reflex assessed excitability of the facial nucleus during the period of post-TMS inhibition (experiment 1). TMS effect on the cortical control of brainstem reflexes was assessed by delivery of a stimulus that was less than or equal to the threshold for the R1 with the subject relaxed, yet elicited a potentiated reflex during maneuvers requiring cortical input (i.e., voluntary eye-closure and anticipation, experiment 2). In experiment 1, a suprathreshold electric stimulus applied during post-TMS inhibition elicited an R1 response that was preserved in amplitude (mean 476 +/- 44 microV; 123%) compared to control responses not preceded by TMS (mean 386 +/- 31 microV). Conversely, in experiment 2, when the R1 was dependent on cortical drive, the mean R1 amplitude during post-TMS inhibition was only 15% (P < 0.01) and 8% (P < 0.01) of control values obtained during eye-closure and anticipation, respectively. These findings imply that the inhibition following TMS originates rostral to the facial nucleus, at a cortical level.

Development and reversal of fatigue in human tibialis anterior.

The lack of easily measurable, objective physiologic indices of muscle fatigue in humans has hampered the evaluation of interventions that putatively inhibit muscle fatigue. In 6 healthy subjects, isometric fatigue of right and left tibialis anterior (TA) was produced using 180 s of intermittent electrical stimulation to the motor point (40 Hz, 650-ms or 250-ms trains, 1 train/s). The time course, magnitude, and reproducibility of fatigue and recovery from fatigue was established, and the effect of duty cycle measured. During fatigue, force fell rapidly in all subjects over the first 70 s, then fell more slowly. Recovery was also biphasic--force increased rapidly over the initial 30 s then slowly--and was incomplete at 300 s. Comparing duty cycles of 0.65 versus 0.25, the longer duty cycle caused a greater fall in force (-65% versus -29%; P < 0.001) and lower recovery (P < 0.02). In all subjects, left leg muscles fatigued more than right. We conclude that this noninvasive fatigue and recovery protocol is highly reproducible and that it may prove useful for evaluating the effects of pharmacologic or restorative interventions on human muscle fatigue.