Tactile and pain thresholds in patients with myofascial pain of the jaw muscles: a case-control study.

AIMS: To compare the tactile detection threshold, the filament-prick pain detection threshold, the pressure pain threshold, and the pressure pain tolerance detection threshold at multiple measuring points in the orofacial region and at the thenar muscle of symptom-free subjects and patients with myofascial pain of the masticatory muscles. METHODS: Twenty patients (age range: 25 to 55 years) and 20 healthy subjects (age range: 25 to 55 years) were recruited. The tactile detection threshold and the filament prick-pain detection threshold were measured at the cheek skin overlying the central part of the left and right masseter muscles, at the right thenar muscle and at the tip of the tongue, using Semmes-Weinstein monofilaments. The pressure pain threshold and the pressure pain tolerance threshold were measured at the central part of the masseter muscle and on the thenar muscle, using a pressure algometer. The intensity of pain perceived during the assessment of filament prick-pain detection threshold, pressure pain threshold, and the pressure pain tolerance threshold was scored on visual analog scales. RESULTS: The tongue tip had the lowest filament prick-pain detection thresholds as compared to the other sites. Filament prick-pain detection thresholds of the tongue and thumb sites were significantly lower in myofascial pain patients than in controls. Pressure pain thresholds of the masseter and thenar muscles were significantly lower in patients with myofascial pain than in control subjects whereas pressure pain tolerance thresholds did not differ significantly between patients and controls. CONCLUSIONS: The findings of the present study show topographic variations in the pain responses to different stimulus modalities. Different pain responses were also found between patients with myofascial pain and control subjects and were interpreted to support theories of centrally mediated pain for temporomandibular disorders.

Percutaneous radiofrequency thermal ablation for hepatocellular carcinoma.

BACKGROUND: Radiofrequency thermal ablation is the first therapeutic option in percutaneous treatment of hepatocellular carcinoma but data on its long-term efficacy and safety are not conclusive. AIM: This study reports a prospective survey on radiofrequency thermal ablation in north-east Italy. METHODS: Data were collected on 401 patients with hepatocellular carcinoma (males 301, mean age: 68 years) treated by radiofrequency thermal ablation in 13 centres. Indication to treatment was: single nodule not eligible for surgery in 77% of patients, 2-3 nodes in 18% and multiple lesions in 5%. Mean size was 3 cm (1-8 cm). Treatment response was assessed at 1 month by spiral computerized tomography and then with ultrasound examination and new spiral computerized tomography. RESULTS: Complete response was obtained in 67% of patients and in 27% response was 75-99%. Complete response raised to 77% in lesions smaller than 3 cm. The morbidity rate was 34%; the mortality was 0.5%, seeding was observed in four patients. Ten patients presented an unexpected rapid disease progression. CONCLUSION: The above data show that by radiofrequency thermal ablation, complete response can be achieved only in about two-third of the cases, clearly less than expected, and that, beyond seeding, unexpected progression can be observed.

Development of brush border peptidases in human and rat small intestine during fetal and neonatal life.

The cytosol peptidase activities hydrolyzing glycl-L-leucine and L-leucyl-glycine as well as the activities of the brush border peptidases (oligoaminopeptidase, aminopeptidase A, gamma-glutamyl-transpeptidase, dipeptidyl-aminopeptidase IV, and carboxypeptidase) are present in rat fetuses during the early differentiation of the intestine (17th to 19th days of fetal life); they increase then at a different rate, reaching a maximum at various times, in the second and third wk after birth, and then decrease to the adult values during the first month of postnatal life. Only the oligoaminopeptidase activity increases steadily after birth, reaching maximal activity in the last decade of the first month. In human fetuses aged between 8 and 22 wk, the gamma-glutamyltranspeptidase was the only brush border peptidase found to be higher than in adults and children. On the other hand, the aminopeptidase A is remarkably reduced. The dipeptidylaminopeptidase IV and the carboxypeptidase are already at adult level in the youngest fetuses, and the oligoaminopeptidase increases during the period of fetal life studied; at the end of this period, the enzyme activity does not differ from the values found in children and adults. The small intestine of the term and preterm newborn should, therefore be able, with some possible exceptions, to efficiently digest peptides.