Prednisolone treatment reduces the osteogenic effects of loading in mice.

Glucocorticoid treatment, a major cause of drug-induced osteoporosis and fractures, is widely used to treat inflammatory conditions and diseases. By contrast, mechanical loading increases bone mass and decreases fracture risk. With these relationships in mind, we investigated whether mechanical loading interacts with GC treatment in bone. Three-month-old female C57BL/6 mice were treated with high-dose prednisolone (15 mg/60 day pellets/mouse) or vehicle for two weeks. During the treatment, right tibiae were subjected to short periods of cyclic compressive loading three times weekly, while left tibiae were used as physiologically loaded controls. The bones were analyzed using peripheral quantitative computed tomography, histomorphometry, real-time PCR, three-point bending and Fourier transform infrared micro-spectroscopy. Loading alone increased trabecular volumetric bone mineral density (vBMD), cortical thickness, cortical area, osteoblast-associated gene expression, osteocyte- and osteoclast number, and bone strength. Prednisolone alone decreased cortical area and thickness and osteoblast-associated gene expression. Importantly, prednisolone treatment decreased the load-induced increase in trabecular vBMD by 57% (p < 0.001) and expression of osteoblast-associated genes, while completely abolishing the load-induced increase in cortical area, cortical thickness, number of osteocytes and osteoclasts, and bone strength. When combined, loading and prednisolone decreased the collagen content. In conclusion, high-dose prednisolone treatment strongly inhibits the loading-induced increase in trabecular BMD, and abolishes the loading-induced increase in cortical bone mass. This phenomenon could be due to prednisolone inhibition of osteoblast differentiation and function.

Hyperventilation in the vestibular clinic: use of the Nijmegen Questionnaire.

The objective of the present study was to determine the prevalence of hyperventilation syndrome in patients seen for vestibular assessment and to assess the clinical utility of the Nijmegen Questionnaire in this group. The Nijmegen Questionnaire and Dizziness Handicap Inventory (DHI) were administered prospectively to a consecutive series of 100 patients identified as candidates for vestibular assessment within the University Hospital Neuro-otology practice. Twenty-three per cent of patients seen for vestibular assessment were diagnosed with hyperventilation syndrome using the Nijmegen Questionnaire. Seventeen of these (74%) would have remained undetected had the Nijmegen questionnaire not been used. No relationship was found between vestibular assessment results and either Nijmegen or DHI scores. A significant correlation was found between DHI scores and Nijmegen Questionnaire scores (rho = 0.348, P = 0.0005). In conclusion, the Nijmegen Questionnaire is a quick, easy to administer and low-impact assessment tool for hyperventilation syndrome and is a useful adjunct to the otological consultation. Diagnosed patients can then be offered breathing control exercises as part of a vestibular rehabilitation programme.

Effects of mouthrinses with linseed extract Salinum without/with chlorhexidine on oral conditions in patients with Sjögren's syndrome. A double-blind crossover investigation.

OBJECTIVES: To study the effect of mouthrinses with salivary replacement substances on oral conditions in patients with primary Sjögren's syndrome. DESIGN: Cross-over, double-blind study. SETTING: Facilities at the Centre for Oral Health Sciences, Malmö University and at Malmö University Hospital, Malmö, Sweden. SUBJECTS: Twenty-two patients with Sjogren's syndrome. INTERVENTION: Linseed extract Salinum alone (Sal) or with addition of chlorhexidine (Sal/Chx) was used for mouthrinsing during 3-week periods of rinsings separated by a 3-week "wash-out" period. MEASUREMENTS: Recordings of percentages of sites with dental plaque and bleeding on probing, mirror friction test and microbiological analyses. Questionnaire on oral symptoms due to reduced salivation. RESULTS: Dental plaque and bleeding on probing were reduced after Sal and after Sal/Chx. Friction was reduced after both treatments. No significant differences for counts of studied microbial groups were seen after Sal but the total anaerobically cultured microorganisms and of mutans streptococci fell after Sal/Chx (p<0.05 and p<0.001). Symptoms of oral dryness improved following Sal and Sal/Chx (p<0.05 and p<0.001 respectively). Speaking problems and burning mouth symptoms improved after use of Sal (p<0.05). CONCLUSIONS: Positive effects on symptoms in patients with Sjögren's syndrome were seen after use of Salinum without or with chlorhexidine.

A controlled trial of self-help treatment of recurrent headache conducted via the Internet.

The Internet can reach a large number of people at a low cost and offers the opportunity for 2-way communication. The present study was designed to evaluate the effects of applied relaxation and problem solving in the treatment of recurrent headache when implemented via the Internet and E-mail. A group of 102 headache sufferers were randomized to 2 conditions: a 6-week treatment condition or a waiting-list control. The dropout was proportionately large (56%), and at the end of the study there were 20 participants in the treatment condition and 25 participants in the control condition. Results showed statistically significant reductions in headache for the treated participants. In 50% of these, the reduction was clinically significant. The Internet has the potential to serve as a complement in the treatment of recurrent headache and deserves further study.

Oral mucous membrane flora in patients using saliva substitutes.

UNLABELLED: Salivary substitutes are sometimes valuable for elderly people and radiotherapy patients, and may be used indefinitely. It is possible that this change in the ecology may effect the oral flora. OBJECTIVE: To analyse the presence of micro-organisms on oral mucous membranes during use of saliva substitutes. DESIGN: Cross-over single-blind study. SETTING: Clinic for Maxillofacial Surgery, Malmö University Hospital and Department of Oral Microbiology, Malmö University. SUBJECTS: 19 patients with low salivary secretion who had been radiated for cancer in the head and neck region. INTERVENTION: Two saliva substitutes: linseed extract and a carboxymethyl cellulose preparation (Salinum and MAS-84) were used for 3 week periods. MEASUREMENTS: Microbial samples taken, processed and analysed. RESULTS: No differences were observed when comparing baseline values with the results after the saliva substitutes and no significant differences between the use of different agents. CONCLUSION: The study suggests that use of linseed extract and carboxymethyl cellulose preparation during periods of weeks does not influence flora commonly related to caries, periodontitis or infections in the oral mucous membranes.

Regional cerebral blood flow during tinnitus: a PET case study with lidocaine and auditory stimulation.

Brain imaging of tinnitus has suggested central correlates of tinnitus perception. This study presents positron emission tomographic (PET) measurements of regional cerebral blood flow (rCBF) in a female tinnitus patient with bilateral left dominant tinnitus. Lidocaine infusion (75 mg during 5 min (0.2 mg/kg/min)) resulted in a 75% reduction of tinnitus and a temporary abolition of the dominant tinnitus in her left ear. Regional CBF was measured in four conditions: i) at rest while concentrating on tinnitus, ii) following maximum effect of lidocaine, iii) during sound stimulation, and iv) the following day at rest while concentrating on tinnitus. Subtraction analyses showed that tinnitus was associated with increased rCBF in the left parieto-temporal auditory cortex, including the primary and secondary auditory cortex with a focus in the parietal cortex (Brodmann areas 39, 41, 42, 21, 22). Activations were also found in right frontal paralimbic areas (Brodmann areas 47, 49 and 15). Sound stimulation resulted in bilateral activation of auditory areas. It is suggested that tinnitus is processed in primary, secondary and integrative auditory cortical areas. Tinnitus perception may involve areas related to auditory attention, while emotional processing relates to temporofrontal paralimbic areas.

A comparison of osteopathic spinal manipulation with standard care for patients with low back pain.

BACKGROUND: The effect of osteopathic manual therapy (i.e., spinal manipulation) in patients with chronic and subchronic back pain is largely unknown, and its use in such patients is controversial. Nevertheless, manual therapy is a frequently used method of treatment in this group of patients. METHODS: We performed a randomized, controlled trial that involved patients who had had back pain for at least three weeks but less than six months. We screened 1193 patients; 178 were found to be eligible and were randomly assigned to treatment groups; 23 of these patients subsequently dropped out of the study. The patients were treated either with one or more standard medical therapies (72 patients) or with osteopathic manual therapy (83 patients). We used a variety of outcome measures, including scores on the Roland-Morris and Oswestry questionnaires, a visual-analogue pain scale, and measurements of range of motion and straight-leg raising, to assess the results of treatment over a 12-week period. RESULTS: Patients in both groups improved during the 12 weeks. There was no statistically significant difference between the two groups in any of the primary outcome measures. The osteopathic-treatment group required significantly less medication (analgesics, antiinflammatory agents, and muscle relaxants) (P< 0.001) and used less physical therapy (0.2 percent vs. 2.6 percent, P<0.05). More than 90 percent of the patients in both groups were satisfied with their care. CONCLUSIONS: Osteopathic manual care and standard medical care had similar clinical results in patients with subacute low back pain. However, the use of medication was greater with standard care.

A meta-analytic review of psychological treatments for tinnitus.

Meta-analysis is a technique of combining results from different trials in order to obtain estimates of effects across studies. Meta-analysis has, as yet, rarely been used in audiological research. The aim of this paper was to conduct a meta-analysis on psychological treatment of tinnitus. The outcomes of 18 studies, including a total of 24 samples and up to 700 subjects, were included and coded. Included were studies on cognitive/cognitive-behavioural treatment, relaxation, hypnosis, biofeedback, educational sessions and problem-solving. Effect sizes for perceived tinnitus loudness, annoyance, negative affect (e.g. depression) and sleep problems were calculated for randomized controlled studies, pre-post-treatment design studies and follow-up results. Results showed strong to moderate effects on tinnitus annoyance for controlled studies (d = 0.86), pre-post designs (d = 0.5) and at follow-up (d = 0.48). Results on tinnitus loudness were weaker and disappeared at follow-up. Lower effect sizes were also obtained for measures of negative affect and sleep problems. Exploratory analyses revealed that cognitive-behavioural treatments were more effective on ratings of annoyance in the controlled studies. It is concluded that psychological treatment for tinnitus is effective, but that aspects such as depression and sleep problems may need to be targeted in future studies.

Oral implant rehabilitation in irradiated patients without adjunctive hyperbaric oxygen.

In 15 patients treated for malignant tumors in the maxillofacial region, 90 Brånemark implants have been placed in irradiated alveolar bone without adjunctive hyperbaric oxygen therapy. Seventy-eight implants were placed in the mandible and 12 in the maxilla. After a follow-up period of 1 to 8 years, 88 implants are still stable, 27 after 6 to 8 years, 44 after 3 to 4 years, and 17 after 1 to 2 years. Two patients lost 1 implant each, both at an early stage. The success rate is 97.8% according to remaining implants, and prosthesis stability is 100%. Implant treatment for oral rehabilitation can be carried out as a safe and successful procedure in the irradiated patient without adjunctive hyperbaric oxygen therapy.

Folate and neural tube defects. Recommendations from a Danish working group.

A working group was established to evaluate the need for an increased folate intake in Danish women to decrease the risk of neural tube defects (NTDs). NTD are birth defects which include anencephaly, encephalocele and spina bifida. In Denmark the incidence is about 1.4 per 1,000 pregnancies. Folate is a B-vitamin found in most food groups. In case-control studies and randomised studies, a protective effect of folic acid supplements on NTDs has been found. The studies show that a periconceptional folic acid supplement of 360 micrograms to 4 mg daily decreases the recurrence rate of NTDs. Likewise, in the few studies which calculate folate intake from the diet, a lower risk of NTD with higher intake of folate from the diet has been found. The folate intake can be increased by the diet, by folic acid supplements or by fortification of food with folic acid. It is concluded that the incidence of NTDs in Denmark will decrease if the folate intake in fertile women increases. All women planning pregnancy should receive dietary counselling. Women who do not eat according to the Nordic Nutrition Recommendations, and women with an increased risk due to diseases are recommended a supplement of 400 micrograms folic acid daily from a multivitamin/folic acid tablet. Women who have had a child with NTD and women who themselves have NTDs are recommended a supplement of 5 mg folic acid daily. Dietary changes and supplements should be initiated when pregnancy is planned.

Prior treatments in a group of tinnitus sufferers seeking treatment.

BACKGROUND: Tinnitus is a common problem for which many treatments have been proposed and implemented. Patients tend to seek renewed treatment after treatment failure. The aim of this descriptive study was to describe a group of consecutive tinnitus patients in terms of prior treatments received. METHODS: Sixty-nine tinnitus patients seeking treatment were asked about prior treatments and completed the short Tinnitus Effect Questionnaire (TEQ). Four groups were obtained: No treatment (n = 24), acupuncture (n = 19), relaxation (n = 13), and other treatments (n = 13). Six subscales were derived from the TEQ measuring helplessness, capacity for rest, acceptability of change, emotional effects, hearing speech and sounds, and ability to ignore. The groups were compared with multivariate analyses of covariance and Tukey's post-hoc tests. RESULTS: Results showed minor differences between the groups, the exception being that the untreated group showed more acceptability for change. CONCLUSIONS: Clinicians should be aware of the fact that patients may have tried at least one treatment when entering the audiology clinic. Controlled studies are needed in order to avoid the spread of nonspecific and non-effective treatments in the management of tinnitus.

Skeletal muscle changes in patients with chronic heart failure before and after treatment with enalapril.

To evaluate if enalapril treatment can influence skeletal muscle metabolism and histology we investigated 26 patients with congestive heart failure and 20 normal subjects. The patients were treated with enalapril for 3 months in addition to diuretics and digitalis. Biopsies from the lateral vastus muscle were taken before and after treatment. Citrate synthetase, 3-hydroxyacyl-CoA dehydrogenase and phosphorylase activities were significantly decreased in the patients compared with controls. The number of capillaries per fibre and the number of capillaries surrounding each fibre were significantly decreased among patients. After 3 months of enalapril treatment functional class improved significantly. The lactate dehydrogenase activity increased whereas the oxidative enzymes did not change significantly. The type I, II and II A fibre areas increased significantly after enalapril treatment. We conclude that patients with chronic heart failure have decreased activity of oxidative enzymes and of phosphorylase in skeletal muscle. They also have decreased capillarization in skeletal muscle. These changes were not influenced by enalapril treatment. The increase in muscle fibre area seen after enalapril treatment could be due to increased physical activity. The cause of increased muscle lactate dehydrogenase activity after enalapril treatment needs further investigation.

Iodine. Do we need an enrichment program in Denmark?

A working group was established to evaluate the need for iodine enrichment in Denmark. Judged from studies of urinary iodine excretion and one dietary survey the intake of iodine in Denmark is low compared with recommended intakes. The occurrence of non-toxic goitre is relatively high; between 9 and 13% in elderly women. Furthermore, a high occurrence of toxic goitre has been seen in the western part of Denmark. On the other hand, an increased or a high intake of iodine may lead to hyperthyroidism and thyroiditis. The working group concluded that an increase in iodine intake in the Danish population is needed and the best way to achieve this is to iodize all salt. To avoid side effects of a sudden large increase in iodine intake the initial amount of iodine in salt will only be 2 ppm.

A two-year follow-up examination of a behavioural treatment approach to hearing tactics.

Twenty elderly hearing impaired patients participated in a two-year follow-up study on the effects of behavioural treatment aimed at increasing coping with hearing impairment. Subjects who had received treatment were compared with untreated controls using the Hearing Coping Assessment (HCA) and the Communication Strategies Subscale of the Communication Profile for the Hearing Impaired (CPHI-CSS). The group treatment package included applied relaxation, video self-modelling, exposure, information, and the teaching of hearing tactics. Results showed some effects in favour of the treatment on the HCA at post-treatment, but no differences at follow-up. The results on the CPHI-CSS using pre-treatment HCA scores as covariate showed significant multivariate effects on the subscales measuring maladaptive behaviours, non-verbal strategies, and on the CPHI-CSS total score. No significant multivariate effect was found for the verbal strategies subscale. As no pre-treatment data were available, results on the CPHI-CSS should be interpreted with caution. Overall, the results from this study give some support for the implementation of behavioural treatment in audiological rehabilitation.

Comparison of the effect of the linseed extract Salinum and a methyl cellulose preparation on the symptoms of dry mouth.

The effect of a linseed extract Salinum and a sodium carboxymethyl cellulose preparation called MAS-84 was compared with regard to its effect on the symptoms of dry mouth. Twenty patients with xerostomia, who had been treated for cancer in the head and neck by radiation were recruited from the clinic for maxillofacial surgery, Malmo University Hospital. Following radiation treatment the salivation was severely reduced. The symptoms of a general feeling of a dry mouth, difficulties in chewing and swallowing, taste disturbances, problems with speech and mouth burning were registered on a subjective verbal rating scale. In addition plaque index and gingival bleeding were determined. The study design was crossover and performed single blind. The experimental period was 7 weeks. The patients were randomly divided into 2 groups. One group used Salinum and the other MAS-84 for 3 weeks. The fourth week was a wash out period and for the next three weeks the patients shifted preparation. Each of the preparations was used ad libitum. Registrations of the various parameters were undertaken on days 0, 7 and 21 of the respective period. At the initial examination all patients reported considerable disturbances from mouth-dryness. These symptoms were reduced in 15 patients during the Salinum period and in 9 during the MAS-84 period. The relief was significantly more pronounced during the use of Salinum compared to that during the use of the methyl cellulose preparation. On day 21 plaque and gingival bleeding were significantly reduced during the Salinum period but not during the MAS-84 period. The results of the present study confirm those of a previous pilot study and indicate that the linseed mucilage significantly reduced the symptoms of dry mouth. This effect increased with increasing time of saliva substitute use. The linseed mucilage Salinum appeared to be a suitable saliva replacement in mouth dry patients.

The effect of Salinum on the symptoms of dry mouth: a pilot study.

The effect of a new saliva substitute, Salinum, was tested in 37 patients with severe symptoms of reduced salivation. The majority of the patients had suffered from hyposalivation and dry mouth for more than 8 years. The saliva substitute consisted of a water soluble extract of linseed. The physical properties of this extract are similar to those of the glycoproteins of the salivary secretions. The patients used the saliva substitute for a seven days period. Prior to the use of the extract the patients reported that the most severe symptoms of decreased salivation were a feeling of dryness in the mouth and burning sensations in the tongue, pharynx and oesophagus, The majority of the patients reported that the use of Salinum reduced the symptoms of hyposalivation. Great variation in effect occurred from patient to patient. Generally the patients with the most severe symptoms experienced the greatest relief of the symptoms when they used Salinum. Although of short duration the results of this pilot study indicate that an extract of linseeds may compensate for some aspects of the consequences of reduced salivation. Further studies are needed to elucidate the feasibility of the extract as saliva replacement.

Factors important in the genesis and prevention of occupational back pain and disability.

Back injuries in the work place are rarely caused by direct trauma; typically, they are the result of overexertion. Although problems exist in epidemiological studies of risk factors for low back pain and sciatica, there are seven occupational factors that have been associated with an increased risk in several studies: six physical and one psychological and psychosocial. Of individual factors, age is the most important, while sex and smoking are probable risk factors.