Radiographic analysis of the anterior to posterior open mouth (APOM) cervical spine view: frequency of atlas transverse process overlap of the inferior tip of the mastoid process.

OBJECTIVE: The purpose of this study was to measure the frequency with which the atlas transverse process is overlapped by the inferior tip of the mastoid process based upon radiographic analysis of the anterior to posterior open mouth (APOM) cervical spine view. METHODS: This is a retrospective study. Anterior to posterior open mouth radiographs (N = 120) were obtained from patient files at a chiropractic clinic. Dimensions were bilaterally measured: the vertical distance from the inferior mastoid to the superior margin of the C1 transverse process (C1TP) and the vertical distance from the inferior mastoid to the inferior margin of the C1TP. The percentage of the C1TP occluded by the mastoid process was calculated by determining the occlusal distance. These percentages were grouped into 4 categories: no occlusion, 1% to 50%, 50% to 99%, and 100%. RESULTS: The occlusal distance for the left and right ranged from -7.1 to 19.0 mm and -7.5 to 19.5 mm, respectively. The mean occlusal distance was identical on the left and right sides (4.6 [SD, 5.1 mm] and 4.7 mm [SD, 5.0 mm], respectively). The percentage of occlusion for the left and right transverse processes ranged from 0% to 80% and 0% to 100%, respectively. The mean percentage was 6.4% (SD, 16.4) on the left and 6.2% (SD, 16.3) on the right. CONCLUSION: This study shows that the occlusal distance for the left and right ranged from -7.1 to 19.0 mm and -7.5 to 19.5 mm, respectively. A total occlusion of the C1TP occurred in 1 side of 120 participants in this sample.

Checklist of the caddisflies (Insecta, Trichoptera) of the Upper Midwest region of the United States.

Five hundred and fifty-two caddisfly species are reported from the Upper Midwest region of the United States, an area that includes 13 states and ~ 2 million km2. Of these, 62 species are reported for the first time from the state of Iowa, 25 from Wisconsin, 18 from South Dakota, 12 from Illinois, five from Indiana, four from North Dakota, four from Minnesota, and one from Nebraska. The Upper Midwest fauna contains nearly 40% of all species known from the United States and Canada, as well as 22 species endemic to the region. Overall species richness was highest in Michigan (319 species), Kentucky (296), Minnesota (292), and Wisconsin (284). Differences in state species assemblages within the region largely followed a geographic pattern, with species richness declining in the western prairie states. There are almost certainly further species remaining to be found in this large region.

Chiropractic management of essential tremor and migraine: a case report.

OBJECTIVE: The purpose of this case report is to describe the chiropractic management of a 39-year-old woman with essential tremors and migraine headaches. CLINICAL FEATURES: A 39-year-old woman presented with essential tremors and migraine headaches, which occurred 2 to 3 times per week. The essential tremor was diagnosed in 2000, and migraine headaches with aura were diagnosed when she was 10. Both diagnoses were made by her general medical practitioner. Previous treatments for migraine included propranolol, isometheptene, dichloralphenazone, acetaminophen, sumatriptan, and over-the-counter pain relievers. INTERVENTION AND OUTCOME: The patient received high-velocity, low-amplitude chiropractic spinal manipulation to her upper cervical spine using the Blair Upper Cervical chiropractic technique protocol. There was improvement in her tremors and migraine headaches following her initial chiropractic treatment, with a sustained improvement after 4 months of care. CONCLUSION: This case study demonstrated improvement in a woman with essential tremors and migraine headaches. This suggests the need for more research to examine how upper cervical specific chiropractic care may help mitigate tremors and migraine headaches.

Cessation of cyclic vomiting in a 7-year-old girl after upper cervical chiropractic care: a case report.

OBJECTIVE: The purpose of this case report is to describe chiropractic management of a child with cyclic vomiting syndrome. CLINICAL FEATURES: A 7-year-old girl had a history of cyclic vomiting episodes for the past 4 1/2 years. She also had a 2-month history of headaches and stomachache. INTERVENTION AND OUTCOME: The patient received low-force chiropractic spinal manipulation to her upper cervical spine. There was improvement in her symptoms within an hour after the chiropractic manipulation. Her symptoms only returned after direct trauma to her neck. The recurring symptoms again disappeared immediately after treatment. CONCLUSION: This case study suggests that there may be a role for the use of chiropractic spinal manipulative therapy for treating cyclic vomiting syndrome. Controlled studies are necessary to aid our understanding of this finding.

Inter- and intraexaminer reliability of the Blair protractoview method: examination of a chiropractic radiographic technique.

OBJECTIVE: The purpose of this study was to evaluate the inter- and intraexaminer reliability of the Blair protractoview radiographic method. METHODS: This retrospective study evaluated 25 participants attending a Blair technique seminar. Participants included chiropractic students and doctors of chiropractic with more than 11 years of experience. Participants evaluated 100 Blair protractoview radiographs (oblique nasium). A κ analysis was used to determine the inter- and intraexaminer reliability because of the nominal categorical value of the variables. For the interexaminer reliability, a κ score was given for each examiner combination. The scores were then averaged to give the total interexaminer reliability. RESULTS: The overall interexaminer reliability showed substantial reliability at 0.62. Within-group κ values were as follows: no certification = 0.61, proficiency = 0.66, primary level = 0.61, and advanced level = 0.74. The overall intraexaminer reliability showed outstanding reliability at 0.81. Within-group κ values were as follows: no certification = 0.76, proficiency = 0.84, primary level = 0.82, and advanced level = 0.92. All κ values had a P value < .001. CONCLUSION: The participants in this study showed good inter- and intraexaminer reliability using the Blair protractoview radiographic method.

Upper cervical chiropractic care for a 25-year-old woman with myoclonic seizures.

OBJECTIVE: The purpose of this case report is to describe the chiropractic management using upper cervical techniques of a 25-year-old woman diagnosed with juvenile myoclonic epilepsy (JME). CLINICAL FEATURES: A 25-year-old woman had a history of JME, which was diagnosed at the age of 14 years. Her seizure episodes began shortly after trauma to her cervical spine and the onset of menarche. INTERVENTION AND OUTCOME: After case history and physical examination, the patient received high-velocity, low-amplitude chiropractic spinal manipulation to her upper cervical spine using the Blair upper cervical chiropractic technique protocol. There was improvement in her seizure episodes and menstrual cycles following 12 weeks of chiropractic care. CONCLUSION: This case study demonstrated improvement in a young woman with a seizure disorder after she received upper cervical chiropractic manipulation. This case suggests the need for more rigorous research to examine how upper cervical chiropractic techniques may provide therapeutic benefit to patients with seizure disorders.

Breath ammonia testing for diagnosis of hepatic encephalopathy.

Measurement of arterial ammonia has been used as a diagnostic test for hepatic encephalopathy, but obtaining an arterial specimen is an invasive procedure. The aim of this study was to evaluate the ability of a minimally invasive, highly sensitive optical sensing device to detect ammonia in the breath of patients with end-stage liver disease and to evaluate the correlation of breath ammonia levels, arterial ammonia levels, and psychometric testing. Fifteen subjects with liver cirrhosis and clinical evidence of hepatic encephalopathy underwent mini-mental status examination, number connection test, focused neurological examination, and arterial ammonia testing. On the same day, breath ammonia testing was performed using an apparatus that consists of a sensor (a thin membrane embedded with a pH-sensitive dye) attached to a fiberoptic apparatus that detects optical absorption. Helicobacter pylori testing was performed using the 14C urea breath test. A positive correlation was found between arterial ammonia level and time to complete the number connection test (r = 0.31, P = 0.03). However, a negative correlation was found between breath ammonia level and number connection testing (r = -0.55, P = 0.03). Furthermore, no correlation was found between breath and arterial ammonia levels (r = -0.005, P = 0.98). There is a significant correlation between the trailmaking test and arterial ammonia levels in patients with cirrhosis. However, no correlation was found between breath and arterial ammonia levels using the fiberoptic ammonia sensor apparatus in this small study.

Breath ammonia measurement in Helicobacter pylori infection.

Our aim was to define the utility of breath ammonia measurement in assessing Helicobacter pylori infection. Volunteers breathed into a device containing three fiberoptic NH3 sensors at baseline and after ingesting 300 mg of urea. Breath ammonia levels were compared to the [14C]urea breath test. Thirteen subjects were tested. Before urea ingestion, H. pylori-positive subjects had significantly lower breath ammonia levels than negative subjects (mean +/- SD, 0.04 ppm +/- 0.09 vs 0.49 ppm +/- 0.24, P = 0.002) and had a significantly greater increases in breath ammonia after urea ingestion (range 198-1,494% vs 6-98%). One H. pylori-positive subject underwent treatment and breath ammonia levels shifted from the pattern seen in positive subjects to that seen in negative subjects. In conclusion, breath ammonia measurement for H. Pylori-positive and negative subjects showed distinct patterns. Breath ammonia measurement may be feasible as a diagnostic test for H. pylori.