Symptoms of lumbar spinal stenosis in people with knee or hip osteoarthritis or low back pain: a cross-sectional study of 10,234 participants in primary care.

OBJECTIVE: The aims of this study were to evaluate: the proportion of people reporting symptoms associated with lumbar spinal stenosis (LSS) in primary care programs for knee or hip osteoarthritis (OA) or persistent low back pain (LBP) and; the prevalence of self-reported clinical LSS in these three cohorts, according to two sets of adapted criteria. METHOD: A cross-sectional analysis of baseline data from the Good Life with osteoArthritis in Denmark primary care programs. Self-report LSS symptom questions were administered to participants with knee OA, hip OA, and persistent LBP. The prevalence of eleven LSS symptoms and clinical LSS were calculated for each cohort. RESULTS: A total of 10,234 participants were included in the analysis. A similar proportion of participants in each cohort were female (69%), with a 6- and 7-year older mean age in the knee and hip cohorts compared to the back cohort. A greater proportion of participants with LBP reported LSS symptoms (range 11-71%) than in the hip (11-50%) and knee (8-40%) cohorts. This pattern was observed for all but one symptom. The same pattern was observed for the prevalence of clinical LSS with less than 10% of people in each cohort satisfying the clinical criteria. CONCLUSION: Self-reported LSS symptoms are commonly reported by people treated in primary care for knee or hip OA, although not as frequently as reported by those with LBP. Despite symptoms of LSS being common, only a small proportion of people were classified as having self-reported clinical LSS.

The diagnostic value of three sacroiliac joint pain provocation tests for sacroiliitis identified by magnetic resonance imaging.

OBJECTIVES: The aim of the current study was to investigate the diagnostic value of three sacroiliac (SI) joint pain provocation tests for sacroiliitis identified by magnetic resonance imaging (MRI) and stratified by gender. METHOD: Patients without clinical signs of nerve root compression were selected from a cohort of patients with persistent low back pain referred to an outpatient spine clinic. Data from Gaenslen's test, the thigh thrust test, and the long dorsal sacroilia ligament test and sacroiliitis identified by MRI were analysed. RESULTS: The median age of the 454 included patients was 33 (range 18-40) years and 241 (53%) were women. The prevalence of SI joints with sacroiliitis was 5%. In the whole study group, only the thigh trust test was associated with sacroiliitis, the area under the receiver operating characteristic (ROC) curve (AUC) was 0.58 [95% confidence interval (CI) 0.51-0.65], sensitivity 31% (95% CI 18-47), and specificity 85% (95% CI 82-87). In men, sacroiliitis was associated with all the SI joint tests assessed and multi-test regimens, with the greatest AUC found for at least one positive out of three tests [AUC 0.68 (95% CI 0.56-0.80), sensitivity 56% (95% CI 31-79), and specificity 81% (95% CI 77-85)]. In women, no significant associations were observed between the SI joint tests and sacroiliitis. CONCLUSIONS: Only in men were the SI joint tests found to be associated with sacroiliitis identified by MRI. Although, the diagnostic value was relatively low, the results indicate that the use of SI joint tests for sacroiliitis may be optimized by gender-separate analyses.

[Oral ranula. A follow-up study]. / Mundbundsranula. En efterundersøgelse.

Ranula is a cystic swelling of the floor of the mouth, which is usually unilateral and relatively uncommon. The cyst arises from the sublingual salivary gland. We reviewed 14 patients operated in the period 1976-April 1998. There was no recurrence after marsupialization and after extirpation of the sublingual gland. Fourteen percent of the patients had recurrence after extirpation of the cyst. At the follow-up time (average 8.1 years) 18.2% had complications. We suggest that marsupialization/extirpation of the cyst should be primary treatment. In case of recurrence the sublingual gland should be extirpated.

Sodium dodecyl sulfate polyacrylamide gel electrophoresis of canine urinary proteins for the analysis and differentiation of tubular and glomerular diseases.

A preliminary investigation was performed to evaluate the use of a new, noninvasive technique for the localization of canine renal lesions by electrophoresis of urinary proteins. Urine specimens from six clinically healthy, nonproteinuric dogs and 12 dogs with persistent proteinuria were examined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE). Urine electrophoretic patterns of proteinuric dogs were classified as glomerular (n = 4), tubular (n = 2), or mixed (glomerular and tubular) (n = 6), based on the number and molecular weight of the silver-stained protein bands. Renal tissues from biopsies or necropsies were obtained from eight of the dogs with proteinuric disease. Interpretation of seven of eight electrophoretograms agreed with the histologic interpretation of renal lesions. We concluded SDS PAGE is a potentially valuable technique for detection and localization of renal lesions in dogs with proteinuric disease.

Gravity constraints in infant motor development.

The effect of gravity in determining if and when during infancy movements eventuate and the rate at which they develop is unknown. In accordance with intersegmental relationships (Hof, 1992), a muscle moment during infancy would have to develop more rapidly than the gravitational moment before movement could occur. In this investigation, the effect of growth through the influence of gravity on the joint moments in the axial region when infants were in a prone or supine posture was examined. A mathematical model that considers the body to be composed of transverse elliptical cylinders, 1 cm deep and of known density, was used in estimating the mass of the 16 segments of the body. The gravitational moments about 3 joints within the axial region (C7-T1, T12-L1, and the hip) were determined by summation, using the radii from the joint transverse axis to the center of mass of the segments. Infants (N = 27) aged between 9 and 36 weeks at the beginning of the study were tested monthly 6 times, and the effect of growth on the gravitational moments was represented by first-order polynomials. Age x Joint analysis of variance (ANOVA) of the mean slopes of the regressions for the gravitational moments revealed significant main effects for age and joint. The means increased monotonically with the number of segments and decreased as infants aged. The mean slopes of the neck and trunk joints were significantly smaller than that of the hip joint. With increasing age, the gravitational slope was significantly smaller. The changes in the gravitational moments during infancy are seen as likely control parameters effecting phase shifts in motor patterns during development.

Changes in segment mass and mass distribution during pregnancy.

The purpose of the study was to evaluate the rates of change in the estimated masses and principal moments of inertia of the body segments during the second and third trimesters of pregnancy. Fifteen subjects, on average 15.1 weeks pregnant, were tested monthly until term. The body was modelled as 16 segments consisting of 2 cm stacked elliptical cylinders sectioned in the transverse plane. Linear regressions were fitted to the segment inertias and regression coefficients determined for the individual growth curves. The mean rate of increase for the lower trunk mass was 0.29 kg per week and 0.0069 kg m2 per week for the transverse axis principal moment. Differences between the means of the segments for rates of change of mass and the three principal moments were then tested. All four ANOVAs used to test the differences were significant. The post hoc analysis established that over the second and third trimesters the lower trunk inertias increased at a greater rate than all other segments and there were no significant differences between the remaining segments. The effect of such changes in the trunk segment masses and principal moments was illustrated by an analysis of intersegmental dynamics during a sit to stand of one pregnant subject whose lower trunk mass increased from 21.6 kg to 28.4 kg. A knowledge of the differences in an individual's segment inertias should lead to a better understanding of how movements are affected during pregnancy.

The application of segment axial density profiles to a human body inertia model.

The intention of this study was to construct segment density profiles and compare segment inertias calculated when uniform densities and profile densities are used in a mathematical model. Axial densities from computerized tomography (CT) slices for the body segments of a sample of Chinese females (Zheng et al., Proceedings of the Beijing Asian Games Scientific Congress, 1990) were used to form profiles which could be employed in body segment models. Polynomials based on proportion of segment length were fitted to the reported mean slice densities. These profiles were then used with five widely divergent samples (n = 10); young adult females, young adult males, infants, male children and elderly adults. The mathematical model used is based on an assumption that all segments can be represented by stacked elliptic cylinders. The results show that when the profile densities were substituted for average cadaver densities the increase in the estimated total body mass was less than 0.85%. For the individual segments, use of the profile rather than average density increased the average segment mass estimate by up to 2.7%. The centres of mass and the principal moments were affected by the variations in density along the axis as well as the magnitudes, by up to 0.54 and 3.8%, respectively. Although the effects of using the profiles appear to be small the differences for individual samples, segments and parameters ranged up to 22.5%. It is not possible to decide if average or profile densities produce more accurate estimates of inertia, but the profile allows for axial variation in density and is therefore recommended.

Distribution of mass to the segments of elderly males and females.

The comprehensive study of the motion of elderly men and women requires the knowledge about the distribution of the body mass to the segments. Cadaver studies are of older subjects and should provide this information. However, the small samples are primarily male and do not represent the body mass of the elderly. In this study a mathematical model which utilizes the shape of the front and side outlines to calculate segment volume, and subsequently mass, is used. Substantive modifications were made to expedite the original technique [Jensen, J. Biomechanics 11, 349-358 (1978)] by using images from two cameras and digitizing software to determine cross-sectional axes as segments are outlined. The revised technique was used in a study of 12 females and seven males, each 63-75 yr. The mean error for body mass estimation was 0.05% (S.D. 2.96%). The calculated masses were compared to estimated masses based on Dempster [Technical Report 55-159, Wright-Patterson Air Force base, Ohio (1955)], and for females, the Dempster proportions overestimated head and forearm mass and underestimated arm and thigh mass (p > 0.05). For males, the head mass was overestimated. The differences between male and female segment masses were then evaluated. Differences for all segments were significant, with the exception of the upper trunk and thigh. When body mass was considered, the female thigh and foot proportions were larger and the lower trunk, forearm and hand proportions smaller.(ABSTRACT TRUNCATED AT 250 WORDS)

Human morphology: its role in the mechanics of movement.

Growth across the lifespan of males and females produces change in the form and structure of the human body which must be recognized in biomechanical models. The different morphologies for age span, gender and racial groupings have been identified and quantified by anthropometrists working primarily with measuring sticks and tapes. These parameters are not the parameters used to solve the dynamics problems of human movement. Models of the body composed of joints and rigid links have been formed and the inertial properties of the segments are required. The research which has been conducted to estimate these segment inertias is incomplete, dispersed, often flawed and inconclusive. However, it is essential that we have a reasonable understanding of the differences in inertia between individuals and changes of inertia within the individual regardless of age, sex and race. Segment inertia parameters can provide valuable insight into growth and the differences between individuals and populations. Segment morphology ranges from embryonic to excessive and each stage of growth or development has potential for the investigation of relationships between shape, size, inertia, weight and movement. The purpose of this paper is to examine research into segment inertias which provides useful information about the differences and changes to be expected. Although some guidance is provided, particularly with respect to bench mark studies, the paper is not intended as a discussion of methodologies. The studies which are pertinent to changes and differences in inertia make it clear that there are many interesting differences between age spans and, within these, differences between males and females and between races. If, in place of the expediency of proportions, segment parameters were measured and integrated into all studies, we would have a more complete representation of morphological changes and differences.

Effects of dietary retinyl acetate on the promotion of hepatic enzyme-altered foci by polybrominated biphenyls in initiated rats.

Vitamin A inhibits the development of some chemically-induced tumours. Since polybrominated biphenyls (PBBs) are hepatic tumour promoters and they affect vitamin A homeostasis in rats, we put forward the hypothesis that dietary levels of vitamin A would influence tumour promotion by PBBs. In the study described here, female Sprague-Dawley rats were initiated on day 1 by ip administration of diethylnitrosamine. On day 7 after initiation, the rats were fed a vitamin A-deficient basal diet that was supplemented with either 2000 IU (low-vitamin A) or 200,000 IU (high-vitamin A) retinyl acetate/kg feed. From day 30 after initiation until the end of the study the following PBBs were added to the diets: Firemaster BP-6 (10 ppm), 2,4,5,2',4',5'-hexabromobiphenyl (10 ppm) or 3,4,5,3',4',5'-hexabromobiphenyl (1 ppm). The control animals received low- or high-vitamin A diets containing no PBBs. On day 180, the rats were necropsied, sections of various tissues were stained for histopathological examination and an evaluation of hepatic enzyme-altered foci was performed. Numbers of gamma-glutamyl transpeptidase-positive foci/cm3 liver and the mean volumes of these foci were lower in the high-vitamin A groups than those in the corresponding low-vitamin A groups, but these differences were not significant. The percentage of the liver volume occupied by foci was significantly greater in the low-vitamin A with 345-HBB group than in the corresponding high-vitamin A group. Thus, high dietary levels of vitamin A had some inhibitory effect on the promotion of hepatic-altered foci by 345-HBB in initiated rats.

Effect of hexachlorobiphenyl on vitamin A homeostasis in the rat.

Vitamin A status and turnover were examined in rats that had been exposed to chronic dietary treatment of 3,4,5,3',4',5'-hexachlorobiphenyl (HCB), 1 mg/kg diet. HCB caused hepatic depletion and renal accumulation of vitamin A, and a 1.7-fold increase in the serum retinol concentration. Intravenously administered [3H]retinol bound to retinol binding protein-transthyretin complex (RBP-TTR complex) was used to study the dynamics of circulatory retinol in these rats. In HCB-treated rats, the plasma turnover rate of retinol was increased compared to vitamin A-adequate untreated controls. HCB caused a 50% reduction of total radioactivity in liver, and, except for 0.5 h after the [3H]retinol-RBP-TTR dose, the specific activity of the hepatic retinyl ester pool was greater compared to control rats. The kidneys of HCB-treated rats accumulated radioactivity in the retinyl ester fraction. HCB also caused a 50% reduction in adrenal radioactivity compared with control rats. Urinary and fecal excretion of radioactivity was 3-fold higher in HCB-treated rats as compared to controls. Our findings demonstrate that chronic HCB feeding results in expansion of plasma vitamin A mass, in changes of liver and kidney retinol and retinyl ester pool dynamics and in an increased metabolism of vitamin A.

Changes in segment inertia proportions between 4 and 20 years.

Growth between 4 and 20 yr produces an increase in body mass and a redistribution of that mass throughout the body. It is the purpose of this investigation to describe changes in the segment mass, radius to the mass centre and radius of gyration for a sample of males, 4-20 yr and the potential effects of these changes on joint reaction forces and moments. The data were collected annually over 9 yr in a mixed longitudinal study completed in 1985. Elliptical zones 2 cm wide were used to model the 16 segments of the body. From these and reported segment densities, mass, the coordinates of the mass centre and the principal moments of inertia were determined for the segments and the body. The parameters reported are the inertia parameters suitable for a sagittal planar analysis with the head and neck considered one segment and values given for other fused segments. The accuracy of the method was judged against the total body mass, and other accuracy estimates from the literature were examined. The parameters are presented as proportions of total mass or segment length. It is clear from the polynomial regressions that there is a substantial redistribution of the mass between segments and this is consistent with the principles of cephalo-caudal and distal-to-proximal development. The proportions for radius and radius of gyration indicate that mass redistribution within segments is comparatively small. The parameters for a 6 yr-old were compared to the parameters expected at 18, 24 and 54 yr and substantial differences noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth of segment principal moments of inertia between four and twenty years.

Although there have been numerous studies of the moments of inertia of the body segments using a variety of the techniques, few have reported the principal moments and none has considered the changes in the principal moments during childhood and adolescence. The purpose of this study was to use a mathematical model to determine the intraindividual changes and interindividual differences in the segment principal moments during growth. The body was modelled as 15 segments and composed of transverse elliptical zones of known density. Moments and products of inertia about the segment mass centroid were calculated and the principal moments and axes determined from the ellipsoid of inertia. A mixed longitudinal study of 12 boys over 9 yr for a total of 88 annual recordings covering the age range 4 to 20 yr was conducted. Polynomial regressions fitted to the intraindividual changes showed a similarity in the curves to 10 yr followed by a wide divergence of growth patterns. The changes in the principal moments across age follow the principles of cephalocaudad and distal to proximal development for all three axes. These changes are more accentuated than the changes for segment length, volume, or mass. The results were consistent with principal moments reported for cadavers and young male adult gamma radiation scans as well as estimates based on simplified models of the segments. The magnitude of the changes in principal moments with age makes it essential that appropriate parameters be used in the analysis or simulation of the movements of children and adolescents.

Effect of dietary retinoic acid on circulatory vitamin A homeostasis in polybrominated biphenyl-treated rats.

Retinoic acid (RA) supplementation is known to lower the amount of retinol in circulation. In contrast, the feeding of polyhalogenated aromatic hydrocarbons results in an elevated level of circulatory retinol. We investigated the effect of short-term dietary exposure to RA on the amount of serum retinol in female Sprague-Dawley rats fed either a basal diet (control rats) or the basal diet containing 100 mg of polybrominated biphenyls (PBBs)/kg diet (PBB-treated rats). After feeding of the above diets for 137 d, RA (12 mg/kg diet) was included in both the control and PBB-containing diets. The rats were fed the RA-containing diet for 3 d and then killed (d 140). Blood samples were obtained before and after RA treatment. Chronic PBB treatment of rats resulted in lower hepatic vitamin A and higher kidney vitamin A than in control rats. Serum retinol concentration was significantly higher in rats treated with PBB for 137 d than in controls; the subsequent treatment with RA lowered serum retinol to a level that was not different from that of control rats treated with RA. Our observations agree with earlier findings that 1) PBB treatment alters vitamin A homeostasis, and 2) dietary RA lowers the amount of circulatory retinol. An important new observation is that serum retinol homeostasis in PBB-treated rats appears to be regulated by a mechanism similar to that of normal rats. Polyhalogenated aromatic hydrocarbons may thus be useful tools to study the control mechanisms of vitamin A homeostasis.

Vitamin A metabolism in rats chronically treated with 3,3',4,4',5,5'-hexabromobiphenyl.

Chronic dietary administration of 3,3',4,4',5,5'-hexabromobiphenyl (HBB), 1 mg/kg diet, caused a decrease in retinol (20-fold) and retinyl esters (23-fold) in the livers of female rats, but resulted in a 6.4-fold increase in retinol and 7.4-fold increase in retinyl esters in the kidneys. Liver acyl-CoA:retinol acyltransferase and retinyl palmitate hydrolase activities were reduced while serum concentration of retinol was unaffected by HBB feeding. Metabolism of a physiological dose of [11-3H]retinyl acetate (10 micrograms), was examined in rats fed either vitamin A-adequate diet, or marginal amounts of vitamin A, or vitamin A-adequate diet containing HBB. A 13-fold greater amount of the administered vitamin A was found in kidneys of HBB-treated rats. In rats fed adequate or low amounts of vitamin A, kidney radioactivity was primarily in the retinol fraction, while in HBB-fed rats the radioactivity was associated mostly with retinyl esters. Fecal and urinary excretion of radioactivity was greatly increased in HBB-treated rats. Chronic HBB feeding results in a loss of ability of liver to store vitamin A, and severely alters the uptake and metabolism of vitamin A in the kidneys. We conclude that HBB causes major disturbances in the regulation of vitamin A metabolism.

Toxic effects of N-nitrosodiethylamine on nasal tissues of Sprague-Dawley rats and golden Syrian hamsters.

The acute necrogenic effects of N-nitrosodiethylamine (NDEA) on nasal tissues of female Sprague-Dawley rats and golden Syrian hamsters were determined. Rats and hamsters were given a single ip dose of 0, 10, 20, 40, or 80 mg NDEA/kg body wt. After 24 hr, the rats and hamsters were killed and tissues were collected. Sections of nasal cavity and liver were evaluated histologically. All doses of NDEA caused inhibition of glycoprotein synthesis in cells of Bowman's glands in the olfactory region of rats and hamsters as determined by the loss of Alcian blue-periodic acid-Schiff staining material. Glycoprotein synthesis in other glands including the lateral nasal glands, maxillary glands, medial nasal glands, and the acinous glands near the vomeronasal organ was not affected by NDEA. Necrosis of Bowman's glands in the olfactory region of the nasal cavity occurred in rats given 20, 40, or 80 mg NDEA/kg body wt whereas the same cells were not necrotic in hamsters given NDEA. The results demonstrate the unique susceptibility of cells of the Bowman's glands to the toxic effects of NDEA given ip and indicate that nasal tissues of the rat are more susceptible to the necrogenic effects of NDEA than those of the hamster.