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PubMedDate not supplied

Depressive symptoms associated with symptoms of the temporomandibular joint pain and dysfunction syndrome.

This paper discusses the findings in the 1012 55-year-old inhabitants of Oulu (a medium-sized Finnish town), 780 of whom (77%) were examined. The purpose was to determine the possible associations between depressive symptoms and subjective and clinical symptoms of the temporomandibular joint pain and dysfunction syndrome (PDS). The PDS symptoms were determined using Helkimo's Clinical Dysfunction Index. Depressive symptoms in 768 subjects were determined using Zung's self-rating depression scale. The prevalences of high rates of depressive symptoms, subjective symptoms of PDS, and clinical symptoms of PDS in the population were 12.2%, 12.0%, and 4.9%, respectively. Subjective symptoms of PDS were more common in depressed dentate men and women than in nondepressed dentate men and women. There was a significantly higher prevalence of subjective symptoms of PDS in depressed edentulous women than in nondepressed edentulous women. There were significantly more moderate or severe clinical symptoms of PDS in depressed dentate women than in nondepressed dentate women. A similar trend was seen in dentate men. An integrated approach is of crucial importance in the diagnosis and treatment of depression and the temporomandibular joint pain and dysfunction syndrome.

Depressive Disorder↗
PubMed2005

Impact of duty hour limits on resident training in otolaryngology.

HYPOTHESIS: Implementation of Accreditation Council for Graduate Medical Education (ACGME) duty hour standards has had limited effects on resident training in otolaryngology. STUDY DESIGN: Retrospective survey of residents and residency program directors (PDs). METHODS: Surveys were mailed to residents and PDs in otolaryngology asking about compliance with ACGME duty hour standards and perceptions of changes brought on by the new regulations. RESULTS: : Surveys were returned by 53.5% of PDs and 29.9% of residents. A majority of PDs described changes made to achieve compliance as "minor;" this consisted most commonly of altering call structure, although some programs hired new support staff or faculty. Mean estimated costs for changes were $14,211. Residents reported working a mean of 67.5 hours per week. Among PDs and residents, only 60% to 70% reported always being in compliance with the main components of the duty hour standards. Residents were largely divided in their opinions as to whether the duty hour limits had led to improvements in patient care, resident education, fatigue, or errors, although most felt that improvement in resident morale had occurred. PDs were more negative because almost half disagreed that improvement had occurred in any of these areas. CONCLUSIONS: Compliance with ACGME duty hour standards remains challenging in otolaryngology. Neither residents nor PDs agree that implementation of the duty hour standards has led to the intended improvements in patient care or resident education, although most agree that resident morale has improved. Further study of objective patient care and educational outcome measures is indicated to validate the need for this change in residency training.

Accreditation↗
PubMed1984

Hemifield red flicker stimulation in a patient with pattern-sensitive epilepsy.

The provocative effects of paroxysmal discharges (PDs) by lateral, upper, and lower hemifield red flicker stimuli were studied in a 24-year-old female patient with pattern-sensitive epilepsy, who showed a generalized photoconvulsive response. In this patient fullfield red flicker stimulation provoked generalized PDs, whereas hemifield red flicker stimuli showed the following characteristics. (a) Left hemifield red flicker stimulation provoked focal PDs in the right posterior regions. (b) Right hemifield red flicker stimulation, on the contrary, was apparently less effective than the left in provoking focal posterior PDs in the contralateral hemisphere. (c) Lower hemifield red flicker stimulation provoked focal posterior PDs that were slightly more pronounced over the right side. (d) No definite PDs were provoked by upper hemifield red flicker stimulation. These results were considered to be suggestive of the following conclusions. (a) Red flicker from the left lower quadrant of the visual field may be the most potent stimulus in provoking focal posterior PDs. (b) The right occipital lobe may be more sensitive to red flicker stimulation than the left occipital lobe. (c) In consideration of the retinotopic projection from the left lower quadrant of the visual field onto the visual cortex, the right upper lip of the visual cortex is presumed to be the most sensitive to red flicker stimulation. It is suggested that hemifield red flicker stimuli might be useful for EEG examination of the visual cortex in patients with photosensitive epilepsy, who are particularly sensitive to red flicker stimulation.

Adult↗
PubMed1978

A mutation altering some properties of the neutral phosphatase in Chlamydomonas reinhardi: possible post-translational modification of phosphatase structure.

A mutant (PDs-) of Chlamydomonas reinhardi has been isolated which produces an altered neutral phosphatase. The wild-type (PDs+) and mutant (PDs-) phosphatases markedly differed in their thermosensitivities and electrophoretic mobilities. The heterozygous PDs-/PDs+ diploids produced only the wild-type electrophoretic form of the phosphatase. Mixing extracts of PDs- with extracts of various other strains in vitro resulted in the rapid transformation of the PDs- enzymic form into an enzymic variety, the properties (heat sensitivity, electrophoretic mobility) of which were similar to those of the wild-type neutral phosphatase. The results are discussed in relation to the idea that the PDs mutation is located not in the structural gene but rather in a modifying gene acting at the post-translational level.

Chlamydomonas↗
PubMed1994

Plasma-derived serum from hypertensive rats differentially increases growth of cultured arteriolar smooth muscle.

A role for humoral factors in the arterial hypertrophy accompanying hypertension has been suggested, but direct evidence is lacking. We measured [3H]thymidine incorporation of growth-arrested smooth muscle cells, cultured from renal preglomerular arterioles of normal rats and exposed for 12 h to 10% platelet-poor plasma-derived serum (PDS) from male rats with early, benign, one-kidney, one-clip hypertension and paired one-kidney normotensive control rats. In the presence of low background concentrations (1-2%) of fetal calf serum, PDS from hypertensive rats increased [3H]thymidine incorporation up to 117% more than PDS from normotensive rats (P < 0.0001). Results were similar for the < 10,000 mol wt fraction of PDS and for PDS from rats drinking saline vs. water or eating a 7% (high) vs. a 0.45% NaCl diet. PDS from hypertensive rats also differentially increased smooth muscle cell proliferation and c-fos mRNA expression. Platelet-derived growth factor levels in PDS were undetectable (< 0.17 ng/ml). This study provides evidence for altered concentrations of sodium chloride-unresponsive plasma factor or factors in hypertension that result in enhanced growth of arteriolar smooth muscle cells.

Animals↗
PubMed1985

Epileptiform activity induced by changes in extracellular potassium in hippocampus.

Using extra- and intracellular recording techniques, we investigated the induction and frequency modulation of spontaneous epileptiform activity produced by changes in the concentration of extracellular potassium ([K+]o). This paper describes a quantitative relationship between [K+]o and the frequency of spontaneously occurring epileptiform events. Recordings were made from the CA3 subfield of the rat in vitro hippocampal slice preparation. Intracellular microelectrodes were filled with 2 M Cs2SO4 and connected to a 3-kHz, time-share, single-electrode current- and voltage-clamp device. The frequency of spontaneous epileptiform (interictal) discharges was determined from extracellular recordings as a function of [K+]o. Current- and voltage-clamp techniques were used to characterize the intracellular correlate of these epileptiform events. The frequency of bicuculline-induced spontaneous epileptiform discharges was dependent on [K+]o. Below 4 mM [K+]o, spontaneous discharges occurred sporadically in the presence of 10 microM bicuculline. Increasing [K+]o from 5 to 10 mM caused a fivefold increase in the rate of spontaneous discharges. Spontaneous epileptiform discharges also occurred in the absence of bicuculline when [K+]o was increased above 6.5 mM. The rate of these discharges was dependent on [K+]o in much the same way as the discharges induced by bicuculline. For any given [K+]o concentration greater than 6.5 mM, however, the resultant discharge rate was faster than that obtained when bicuculline was present in the bathing solution. Simultaneous intra- and extracellular recordings revealed that the spontaneous high-[K+]o-induced interictal discharge was accompanied by a large depolarization of the membrane potential that appeared similar to the paroxysmal depolarizing shift (PDS) seen with other convulsants. The intracellularly recorded event fulfilled the criteria for a synaptically mediated PDS. The waveform of the PDS was complex and dependent on the membrane potential. When the membrane potential was held at 0 mV, spontaneously occurring hyperpolarizing potentials were noted during the inter-PDS interval. These events were blocked by picrotoxin or bicuculline and were probably spontaneous inhibitory postsynaptic potentials. The complexity of the PDS waveform suggested that more than one synaptic conductance was involved in the generation of the PDS. The mean measured reversal potential of the depolarizing phase was -10.7 mV. Voltage-clamp techniques were used to measure the conductance underlying the depolarizing phase of the high-[K+]o-induced PDS. The mean measured conductance was 51.5 nS, with a reversal potential of -7.9 mV.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1995

Modulation of epileptiform activity by metabotropic glutamate receptors in immature rat neocortex.

1. Intracellular and extracellular recordings were obtained from neocortical brain slices of immature rats (postnatal days 9-16) maintained in vitro. Spontaneous and evoked epileptiform discharges (termed paroxysmal depolarizing shifts or PDSs) were recorded from upper cortical laminae (layers II-III) after exposure to the gamma-aminobuturic acid-A receptor antagonist, bicuculline methiodide. The effects of mGluR activation on PDS duration, spontaneous frequency, and threshold for evoking a PDS were determined. Putative mGluR agonists and antagonists also were tested. 2. Bath application of the mGluR agonist (1S,3R)-1-aminocyclopentane-1,3-dicarboxylate (ACPD, 50-200 mM) elicited biphasic, time-dependent effects on evoked and spontaneous epileptiform discharges. At times early in drug wash-in, ACPD increased PDS duration and spontaneous PDS frequency. In > 60% of the slices, the spontaneous PDSs became regular. Subsequently, ACPD reduced PDS duration and increased the stimulus threshold for evoking a PDS, suggesting that the actions of ACPD were dose dependent. 3. Investigation of the concentration-dependence revealed that sustained low ACPD concentrations (5 microM) elicited only facilitatory actions, whereas higher concentrations were suppressive. These observations suggest the activation of different mGluR subtypes, which may be localized differentially at pre- and postsynaptic sites. 4. Bath application of the mGluR agonists, L-2-amino-4-phosphonobutyrate or (2S,3S,4S)-alpha-(carboxycyclopropyl) glycine, produced only suppressive effects on epileptiform activity in the immature neocortex. L-2-amino-3-phosphonopropionate was an ineffective antagonist of ACPD-mediated modulation of epileptiform activity. Application of the putative antagonist, alpha-methyl-4-carboxyphenylglycine (MCPG), failed to antagonize the biphasic actions of ACPD. MCPG had suppressive effects of epileptiform activity, suggesting activation of mGluRs by endogenous agonists. 5. Simultaneous recordings from deeper and upper cortical layers indicated that the initial negativity of both evoked and spontaneous PDSs began in deeper cortical layers under control conditions and in the presence of ACPD. Intracellular records from neurons in deeper layers displayed two distinct patterns of activity during mGluR activation. Most deep layer neurons received a barrage of excitatory postsynaptic potentials before a spontaneous PDS during ACPD application. A small population of neurons depolarized and entered a tonically firing mode, which was interrupted by spontaneous PDSs. Different neuronal populations, possible expressing different mGluR subtypes or coupling mechanisms, may play integral roles in the induction and generation of epileptiform activities. 6. Thapsigargin or dantrolene, agents thought to block release of Ca2+ from intracellular stores, were both applied for periods < or = min.(ABSTRACT TRUNCATED AT 400 WORDS)

6-Cyano-7-nitroquinoxaline-2,3-dione↗
PubMed1982

Effect of peritoneal dialysis solution on the antimicrobial activity of cephalosporins.

We studied the effect of peritoneal dialysis solution (PDS) on the antibacterial activity of seven cephalosporins, gentamicin, tobramycin and amikacin. The six bacterial species employed in the study survived in a wide range of concentrations of PDS, however, Staphylococcus aureus did not survive beyond 24 h in PDS. There were no physical incompatibilities between any of the antibiotics and PDS. None of the cephalosporins was bactericidal in PDS, whereas, the bactericidal concentrations of the aminoglycosides in PDS approximated those of aminoglycosides in broth. We conclude from these in vitro data that cephalosporins may not be ideal agents for intraperitoneal therapy when they are administered in PDS.

Amikacin↗
PubMed2005

Quality of life in patients with personality disorders seen at an ordinary psychiatric outpatient clinic.

BACKGROUND: Epidemiological studies have found reduced health-related quality of life (QoL) in patients with personality disorders (PDs), but few clinical studies have examined QoL in PDs, and none of them are from an ordinary psychiatric outpatient clinic (POC). We wanted to examine QoL in patients with PDs seen at a POC, to explore the associations of QoL with established psychiatric measures, and to evaluate QoL as an outcome measure in PD patients. METHODS: 72 patients with PDs at a POC filled in the MOS Short Form 36 (SF-36), and two established psychiatric self-rating measures. A national norm sample was compared on the SF-36. An independent psychiatrist diagnosed PDs and Axis-I disorders by structured interviews and rated the Global Assessment of Functioning (GAF). All measurements were repeated in the 39 PD patients that attended the 2 years follow-up examination. RESULTS: PD patients showed high co-morbidity with other PDs and Axis I mental disorders, and they scored significantly lower on all the SF-36 dimensions than age- and gender-adjusted norms. Adjustment for co-morbid Axis I disorders had some influence, however. The SF-36 mental health, vitality, and social functioning were significantly associated with the GAF and the self-rated psychiatric measures. Significant changes at follow-up were found in the psychiatric measures, but only on the mental health and role-physical of the SF-36. CONCLUSION: Patients with PDs seen for treatment at a POC have globally poor QoL. Both physical and mental dimensions of the SF-36 are correlated with established psychiatric measures in such patients, but significant changes in these measures are only partly associated with changes in the SF-36 dimensions.

Adult↗
PubMed2003

Prednisolone 21-sulfate sodium: a colon-specific pro-drug of prednisolone.

Prednisolone 21-sulfate sodium (PDS) was synthesized as a colon-specific pro-drug of prednisolone with the expectation that it would be stable and non-absorbable in the upper intestine and release prednisolone by the action of sulfatase once it was delivered to the colon. In-vitro/in-vivo properties were investigated using rats as test animals. PDS was chemically stable at pH 1.2, 4.5, 6.8 and 8.0, and the apparent partition coefficient was 0.11 in 1-octanol/pH 6.8 buffer solution at 37 degrees C. PDS was stable on incubation with the contents of the stomach or small intestine. When PDS (0.1 mg equiv. of prednisolone) was incubated with the caecal contents (0.05 g), prednisolone was produced to a maximum 54% of the dose in 6 h and decreased thereafter, which suggested that reduction of the A ring took place in addition to the hydrolysis by sulfatase. After oral administration of PDS, a small portion of prednisolone was recovered from the cecal contents but not from the small intestine. Neither PDS nor prednisolone was detected in the plasma, suggesting that absorption of PDS is limited. The data demonstrate that the sulfate ester can serve as a novel colon-specific pro-moiety by limiting the absorption of the pro-drug in the upper intestine and releasing the active compound by the action of microbial sulfatase in the colon.

Administration, Oral↗
PubMed2004

Personality disorders, depression, and coping styles in Argentinean bulimic patients.

This study investigates the coping styles of bulimic patients with personality disorders (PDs) and the effects of the level of depression on the relations between PDs and coping. The sample consisted of 75 Argentinean bulimic outpatients engaged in treatment. Patients completed the SCID II (Structural Interview for DSM IV-Personality Disorders), COPE (Coping Inventory), and the SCL-90-R (Symptom Checklist-90-Revised). No differences in the coping styles of bulimic patients with or without a PD were found. However, when three specific PDs were considered-Avoidant, Obsessive-Compulsive, or Borderline PDs-clear differences in the coping styles of the bulimics were found. However, the differences disappeared when depression was controlled. Regarding the severity of the three specific PDs, coping styles were only found to be associated with the Avoidant PD. Depression showed to affect the relations between coping styles and two specific PDs-Avoidant and Borderline PDs-in bulimic patients.

Adaptation, Psychological↗
PubMed2004

Maternal depression, changing public assistance, food security, and child health status.

OBJECTIVE: To examine the association of positive report on a maternal depression screen (PDS) with loss or reduction of welfare support and foods stamps, household food insecurity, and child health measures among children aged < or =36 months at 6 urban hospitals and clinics. METHODS: A convenience sample of 5306 mothers, whose children <36 months old were being seen in hospital general clinics or emergency departments (EDs) at medical centers in 5 states and Washington, District of Columbia, were interviewed from January 1, 2000 until December 31, 2001. Questions included items on sociodemographic characteristics, federal program participation and changes in federal benefits, child health status rating, child's history of hospitalizations since birth, household food security status, and a 3-question PDS. For a subsample interviewed in the ED, whether the child was admitted to the hospital that day was recorded. RESULTS: PDS status was associated with loss or reduction of welfare support and food stamps, household food insecurity, fair/poor child health rating, and history of child hospitalization since birth but not low child growth status measures or admission to the hospital at the time of ED visit. After controlling for study site, maternal race, education, and insurance type as well as child low birth weight status, mothers with PDS were more likely to report fair/poor child health (adjusted odds ratio [AOR]: 1.58; 95% confidence interval [CI]: 1.33-1.88) and hospitalizations during the child's lifetime (AOR: 1.20; 95% CI: 1.03-1.39), compared with mothers without PDS. Controlling for the same variables, mothers with PDS were more likely to report decreased welfare support (AOR: 1.52; 95% CI: 1.03-2.25), to have lost food stamps (AOR: 1.56; 95% CI: 1.06-2.30), and reported more household food insecurity (AOR: 2.69; 95% CI: 2.33-3.11) than mothers without PDS. CONCLUSION: Positive maternal depression screen status noted in pediatric clinical samples of infants and toddlers is associated with poorer reported child health status, household food insecurity, and loss of federal financial support and food stamps. Although the direction of effects cannot be determined in this cross-sectional survey, child health providers and policy makers should be aware of the potential impact of maternal depression on child health in the context of welfare reform.

Body Weight↗
PubMed2004

Epileptogenicity and epileptic activity: mechanisms in an invertebrate model nervous system.

Epileptic seizures are based on paroxysmal depolarization shifts (PDS) which are synchronized in many neurons. Mechanisms underlying PDS and seizures are still not understood. The present review is based on studies using the buccal ganglia of the snail Helix pomatia as a model nervous system. Essential mechanisms of epileptic activity in nervous systems are thought to be identical in whatever part of the human or animal nervous system epileptic activity appears. From studies using the buccal ganglia of Helix pomatia, epileptic activity is essentially non-synaptic. PDS are "giant pacemaker potentials", which are generated non-synaptically by the single neurons. It is, however, not yet clear which processes transform pacemaker potentials into PDS. Synchronization of PDS follows generation of PDS and results mainly from a non-synaptic, unspecific release of intracellular substances from the dendrites of a PDS-generating neuron to the dendrites of neighbouring neurons. This explains the existence of small epileptic foci. From the above observations epileptogenicity is introduced or intensified when the proteins underlying pacemaker potentials are expressed. The first chapter of the present review presents the model system. The second chapter describes epileptiform activity in the model system to correspond in all aspects to epileptiform activity recorded in vertebrate nervous systems including man. Subsequently, antiepileptic and epileptogenic properties of drugs are described using the buccal ganglia. Two following chapters concern neuronal structures and neuronal functions affected by epileptiform activity, and in the final chapter the mechanisms underlying epileptiform activities are described.

Animals↗
PubMed2001

Benzodiazepines in child dental care: a survey of its use among general practitioners and paediatric dentists in Sweden.

Dental treatment in children too young or too apprehensive to co-operate is often performed under sedation. The aim of this study was to survey the use of rectal and oral liquid and tablet benzodiazepine sedation in Swedish child dentistry, and estimation of treatment success. A questionnaire was sent to 500 randomly selected dentists (GPs) working in the Public Dental Health Service and all (77) specialists (PDs) working at paediatric dentistry clinics. Benzodiazepine sedation was used by 73% of the GPs and 97% of the PDs. Seven per cent of the GPs and 87% of the PDs had sedation sessions at least once a month. Of the GPs, 60% administered the sedation rectally, 7% orally in liquid form, and 39% orally in tablet form. For PDs, the corresponding figures were 97%, 78%, and 68%. Sixteen per cent of the GPs and 84% of the PDs used midazolam for rectal sedation. PDs rated rectal sedation better than the GPs (p < 0.001). GPs rated their experiences of rectal sedation as better the more frequent the use (p = 0.03), as did PDs concerning oral liquid sedation (p = 0.03). Thus, it seems that a more regular use of sedation is advantageous in achieving better treatment outcome.

Administration, Oral↗
PubMed2001

An electronic documentation system increases diagnostic code capture for very low birth weight infants.

INTRODUCTION: Information describing medical interventions and patient outcome of very low birth weight (VLBW; BW <1500 grams) infants who receive neonatal intensive care is necessary to evaluate the quality of health care. We developed an electronic patient documentation system (EDS) called PCode to identify and select patient diagnostic (DX) codes and compared EDS to the previous paper-based documentation system (PDS). Our hypothesis was that EDS would capture more patient diagnostic codes than PDS. METHODS: PDS was originally developed as a two page 'code sheet' which listed all 275 neonatal diagnoses/management options and corresponding 3-4 character diagnostic (DX) codes, organized by organ system. PDS code sheets were manually completed by one of three trained 'coders' for every neonatal patient. EDS was developed as a Java application with the 'coder' selecting DX codes from drop lists also categorized by organ system. The study intervention was patient code selection using either the PDS or the EDS system. Both systems produced a paper DX code summary. PDS data capture occurred from 11/1997-3/1999 followed by EDS data capture until 8/2000. The primary outcome variable was DX codes captured per patient. Data were analyzed using independent t-test and linear regression. RESULTS: The number of diagnoses increased with decreasing birth weight. After linear regression was applied to control for birth weight, the number of DX codes was 31% greater in the EDS group, 7.2 +/- 2.9 DX codes/patient, p=0.008. There was a trend towards fewer erroneous DX codes in the EDS group. The most common DX codes were hyaline membrane disease, sepsis evaluation and hyperbilirubinemia, as expected for this patient population. CONCLUSIONS: EDS captured more VLBW infant DX codes compared to PDS. These results support the transition toward electronic data documentation for the neonatal clinical environment. Electronically linking PCode to the patient database has been initiated and should reduce manual coding errors.

Diagnosis↗
PubMed1995

Hypomagnesemia in continuous ambulatory peritoneal dialysis patients dialyzed with a low-magnesium peritoneal dialysis solution.

OBJECTIVE: Previous studies have shown a decrease in serum magnesium (Mg) concentration when continuous ambulatory peritoneal dialysis (CAPD) patients previously maintained on a 1.0-1.2 mEq/L Mg peritoneal dialysis solution (PDS) were dialyzed with a 0.5 mEq/L Mg PDS. However, the prevalence of hypomagnesemia in CAPD patients dialyzed with low-Mg PDS is unknown. DESIGN: A retrospective study to determine the prevalence of hypomagnesemia and the factors associated with its occurrence in CAPD patients dialyzed using a 0.5 mEq/L Mg PDS. SETTING: A CAPD unit in a large Veterans Affairs Hospital. PATIENTS: All our CAPD patients (33) enrolled over a 52-month period. RESULTS: All patients had serum magnesium levels higher than 1.25 mEq/L prior to use of low-Mg PDS. Hypomagnesemia (serum Mg < 1.25 mEq/L) developed in 21/33 patients (64%) when a 0.5 mEq/L Mg PDS was employed. Hypomagnesemia developed a mean of 8.2 months after beginning treatments. The duration of dialysis and the number of episodes of peritonitis did not differ between patients with and those without hypomagnesemia. Serum albumin levels were significantly lower in patients with hypomagnesemia (2.5 +/- 0.12 g/dL vs 3.2 +/- 0.12, p < 0.01). Magnesium supplements were given to 13 patients; following this therapy, serum magnesium values became normal. CONCLUSIONS: CAPD patients dialyzed with a 0.5 mEq/L Mg PDS may develop a considerable fall in serum magnesium level and may require magnesium supplements in order to restore normal serum values.

Dialysis Solutions↗
PubMed1993

[Results of treatment after different surgical procedures for management of acromioclavicular joint dislocation].

Sixty-four patients underwent surgery for acromioclavicular (AC) disruption, Tossy type III, at the Department of Surgery, University of Heidelberg, between January 1983 and May 1990. Surgery consisted of a suture of the AC and coracoclavicular ligaments. Fixation of the joint was achieved with three different techniques: tension band wire with two Kirschner wires, special hook-plate (Wolter), double tension band fixation using polydioxanon (PDS) cordula. The early postoperative complication rate was higher following tension band wires (42.9%) and hook plate (58.3%) than after tension band PDS cordula (16.7%). The patients were re-examined after an average of 35.3 months. An instability of the AC joint was found in 31.8% of patients with tension band wire, 50.0% of patients with Wolter plate, and 23.8% of patients with tension band PDS cordula. The comparison of these results with those after conservative treatment, as reported in the literature, emphasizes the need for limiting surgery to young adults and athletes. The long term results of AC joint fixation are better using PDS cordula than tension band wire or hook plate. PDS cordula has the additional advantages, that dislocation and fracture of metal implants do not occur, and metal removal is avoided. Therefore, tension PDS cordula is associated with a marked reduction of the overall hospitalization period. Further improvements of results of AC joint fixation can be expected using the described technique of double tension band PDS cordula.

Acromioclavicular Joint↗
PubMed1998

Occupational profile and cardiac risk: possible mechanisms and implications for professional drivers.

There has been at least forty empirical investigations concerning cardiovascular disease (CVD) among professional drivers (PDs). Standard cardiac risk factor status does not consistently distinguish PDs from other lower risk groups. PDs showed more than twice the overall exposure to stressful work factors compared to referents. They also showed lower maximum bicycle exercise level with a higher double product and higher diastolic blood pressure at the end of exercise compared to controls. Catecholamine excretion has been reported to be elevated during driving. Ambulatory measurements showed higher systolic and diastolic blood pressure in drivers before, during and after driving shifts. Using spectral analysis, the low to high frequency ratio was more than doubled towards the end of a 4-hour drive compared to the early one and a linear increase in 0.1 heart rate variability as a function of distance driven. Reactivity to headlight glare has been shown to roughly parallel the degree of CVD severity in PDs with IHD, essential and borderline hypertension. It was postulated that PDs with IHD form a powerful association between the exposure to glare and the stressfulness of driving and this association was resistant to extinction. The occupational medicine specialist "should have the authority to check the patient regularly in the workplace itself (to ascertain whether or not) the decision to return to work is still valid". An integrated diagnostic approach for PDs might entail using exercise stress testing, with evaluation of silent myocardial ischaemia and heart rate variability during work as well as laboratory tests which simulate aspects of their work environment, with catecholamines measured in relation to these procedures. Assessment of left ventricular mass and further evaluation of atherogenic biochemical abnormalities would be of value for further untangling the mechanisms of cardiac risk among PDs.

Adult↗