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PubMed2004

The role of substance P in inflammatory disease.

The diffuse neuroendocrine system consists of specialised endocrine cells and peptidergic nerves and is present in all organs of the body. Substance P (SP) is secreted by nerves and inflammatory cells such as macrophages, eosinophils, lymphocytes, and dendritic cells and acts by binding to the neurokinin-1 receptor (NK-1R). SP has proinflammatory effects in immune and epithelial cells and participates in inflammatory diseases of the respiratory, gastrointestinal, and musculoskeletal systems. Many substances induce neuropeptide release from sensory nerves in the lung, including allergen, histamine, prostaglandins, and leukotrienes. Patients with asthma are hyperresponsive to SP and NK-1R expression is increased in their bronchi. Neurogenic inflammation also participates in virus-associated respiratory infection, non-productive cough, allergic rhinitis, and sarcoidosis. SP regulates smooth muscle contractility, epithelial ion transport, vascular permeability, and immune function in the gastrointestinal tract. Elevated levels of SP and upregulated NK-1R expression have been reported in the rectum and colon of patients with inflammatory bowel disease (IBD), and correlate with disease activity. Increased levels of SP are found in the synovial fluid and serum of patients with rheumatoid arthritis (RA) and NK-1R mRNA is upregulated in RA synoviocytes. Glucocorticoids may attenuate neurogenic inflammation by decreasing NK-1R expression in epithelial and inflammatory cells and increasing production of neutral endopeptidase (NEP), an enzyme that degrades SP. Preventing the proinflammatory effects of SP using tachykinin receptor antagonists may have therapeutic potential in inflammatory diseases such as asthma, sarcoidosis, chronic bronchitis, IBD, and RA. In this paper, we review the role that SP plays in inflammatory disease.

Animals↗
PubMed2002

Conditions and diagnoses for which osteopathic primary care physicians and specialists use osteopathic manipulative treatment.

Data presented in this study were gathered in 1998 through a national mail survey of 3000 randomly selected osteopathic physicians. Of 979 (33.4%) questionnaires returned, 955 (97.5%) were usable for analysis. The use of osteopathic manipulative treatment (OMT) was determined for primary care physicians and specialists. Osteopathic manipulative treatment specialists and family physicians provided OMT significantly more frequently than other primary care physicians and non-primary care specialists. More than 50% of respondents (513) administered OMT on less than 5% of their patients. Nevertheless, it should be noted that physicians from 40 of 46 specialties and subspecialties represented in the survey (678, 71%) identified an average of 3.3 conditions and diagnoses per physician that were managed with OMT. The conditions and diagnoses for which OMT is used have been enumerated and codified. More than 50% of conditions (1135) for which respondents treated patients with OMT related to the musculoskeletal system, but extensive overlap among other body systems and body regions attests to the continued incorporation of OMT into holistic patient care by a broad range of osteopathic physicians.

Analysis of Variance↗
PubMed1988

The period prevalence of musculoskeletal complaints among Swedish professional drivers.

The aim of the investigation was to survey the period prevalence of musculoskeletal complaints among Swedish professional drivers. 460 out of 570 male drivers answered a postal inquiry. The period prevalence of musculoskeletal complaints was highest for the low back, the shoulders, the knees and the neck, in that order. For some parts of the musculoskeletal system the period prevalence of complaints tended to increase with age. A subdivision of the examined group of drivers according to task revealed--after standardizing for age (SRR)--different relative risk of complaints in various anatomical regions of the body. The interaction among some variables was studied by means of Automatic Interaction Detection Analysis. The analysis showed that the variables age and task reduced the variance of the period prevalence of musculoskeletal complaints most.

Adult↗
PubMedDate not supplied

[Risks and health problems caused by the use of video terminals].

OBJECTIVE: To evaluate the association between video display terminal (VDT) use and health hazards, occupational risks, and psychosocial factors, in newspaper workers. MATERIALS AND METHODS: A cross-sectional study was conducted in 1998 in a representative sample (n = 68) drawn from a population of 218 VDT operators in Mexico City. Data were collected using a self-administered questionnaire. Data were confirmed by performing physical examinations. The research hypothesis was that both the current and cumulative use of VDT are associated with visual, musculoskeletal system, and skin illnesses, as well as with fatigue and mental or psychosomatic disorders. Occupational health hazards were assessed (visual problems, postural risks, sedentary work, computer mouse use, excessive heat, and overcrowding), as well as psychosocial factors related to work organization (psychological demands, work control, and social support). Prevalence ratios were adjusted for confounding variables like age, sex and schooling. RESULTS: Women were more likely than men to have upper extremity musculoskeletal disorders (MSD), dermatitis, and seborrheic eczema. VDT use was associated with neuro-visual fatigue, upper extremity MSD, dermatitis, and seborrheic eczema. Computer mouse use and postural risks were significantly associated with health problems. Psychosocial factors were mainly associated with mental problems, psychosomatic disorders, and fatigue. CONCLUSIONS: Intense use of video screens has been found to cause musculoskeletal disorders of the hand. The diversification of tasks and control of labor processes itself had a protective effect against psychosomatic disorders and pathological fatigue.

Adult↗
PubMed2002

Feasibility of ultrasound examination in posterior ligament complex injury of thoracolumbar spine fracture.

STUDY DESIGN: A prospective study of 12 patients with thoracolumbar spinal fractures was conducted. OBJECTIVE: To assess the feasibility of ultrasound examination for posterior ligament complex injury in thoracolumbar spinal fractures. SUMMARY OF BACKGROUND DATA: In posterior ligament complex injury of thoracolumbar spine fracture, the reliability of magnetic resonance imaging (MRI) for diagnosis has been reported. Nevertheless the usefulness of ultrasound for diagnosis has not been studied, whereas diagnostic ultrasound has been applied in the musculoskeletal system. METHODS: Two healthy volunteers without a history of spinal trauma were recruited for pilot examination of the ultrasound procedure to access normal findings of the posterior ligament complex. This study investigated 12 thoracolumbar spine fractures. Four were flexion distraction injury; six were stable or unstable burst fractures; and two were simple compression fractures. Osteoporotic spine fractures were excluded from this study. Ultrasound was performed over the injured area by an experienced musculoskeletal radiologist in addition to radiography and MRI. Five patients underwent operative procedures to stabilize the fractured spine. Imaging data and operative findings were correlated with ultrasound examination. RESULTS: In the patients who did not undergo surgery, agreement in diagnosis between MRI and ultrasound was moderate (5 of 7). Difficulty evaluating ligament status was encountered when the region of interest was the lower thoracic level (T10, T11, T12) because of long overlapping spinous processes. In the patients who underwent surgery, correlation between MRI, ultrasound, and operative findings was excellent, especially in diagnosing the status of the supraspinous and interspinous ligaments. Nevertheless, it is impossible to visualize deep-seated structures (i.e., ligamentum flavum, deep muscles of the spine, and facet joint) with ultrasound. CONCLUSIONS: This study demonstrated the excellent diagnostic ability of ultrasound to detect the status of the supraspinous and interspinous ligaments, especially in patients who undergo surgery. Although ultrasound examination appears to be less sensitive than MRI in predicting ligament status, the cost effectiveness of ultrasound and its use as an alternative to MRI in special situations (i.e., patients with pacemaker, ferromagnetic implant, or severe claustrophobia) should be emphasized. More clinical data concerning the sensitivity, specificity, and accuracy of ultrasound examination should be addressed in future studies.

Adult↗
PubMed1997

Screen-film versus computed radiography imaging of the hand: a direct comparison.

OBJECTIVE: Computed radiography of the musculoskeletal system has the potential to become a powerful tool in the practice of diagnostic radiology. It addresses many of the geographic and film-distribution concerns facing diagnostic imaging. We undertook this study to compare and document the quality of computed radiographs and conventional screen-film images before widespread implementation. MATERIALS AND METHODS: We evaluated clinical images using direct comparison. Bilateral hand images from 50 patients were scored independently by six musculoskeletal radiologists. In each case one hand was imaged with a conventional screen-film technique and the other with computed radiography. Images were masked to eliminate as much bias as possible. The numeric scores assigned to the images by the observers were analyzed using Student's t test. RESULTS: Computed radiographs were judged with statistical significance to be better than conventional screen-film images in all features judged by the observers, including bone cortex, bone trabeculae, corticomedullary junction, distal phalangeal tuft, soft tissues, fat planes, bone-soft-tissue interface, and overall contrast and density. CONCLUSION: The statistically significant determination that the image quality of computed radiographs is at least as good as screen-film images allows confident use of computed radiography and enables radiologists to take advantage of its many other practical capabilities related to image distribution, storage, cost, and geographic coverage without sacrificing image quality.

Adult↗
PubMed1980

Patient-physician concordance in problem identification in the primary care setting.

We analyzed how often patients and physicians identified the same principal problem for 439 return primary care visits. Agreement between the patient and physician, called concordance, was scored as complete when both cited a problem in the same organ-system (208 visits; 47%); as partial when the patient cited a problem that was anywhere but first on the physician's problem list but both parties agreed on the biological or psychosocial nature of the principal problem (114 visits; 26%); or as absent (117 visits; 27%). Concordance scores were significantly lower when physicians identified a principal psychosocial problem or when patients identified a principal problem related to psychosocial issues, preventive medicine, the musculoskeletal system, or accidents. Because physicians in the Primary Care Internal Medicine Training Program were significantly more likely to identify principal psychosocial problems, their concordance scores were significantly lower than those of standard internal medicine track physicians.

Attitude to Health↗
PubMed2002

Infection in Thai patients with systemic lupus erythematosus: a review of hospitalized patients.

Infection is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The authors conducted retrospective review of 488 admissions at King Chulalongkorn Memorial Hospital during a 5-year period (1994-1999) to determine the infectious complications in these patients. One hundred ninety-one patients with SL2 were admitted because of infection. Lower respiratory tract infection was the most commonly found in these patients (24.6%) followed by infections of the urinary tract (15.7%), skin (15.7%), septicemia (13.6%) and the musculoskeletal system (11.5%). The most common pathogens were Salmonella spp (12.6%), while Escherichiae coli (9.9%) and Mycobacterium tuberculosis (8.4), respectively.

Adrenal Cortex Hormones↗
PubMed1993

Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization.

OBJECTIVE: To establish basic epidemiological data on chronic pain (duration > 3 months) in a defined population. Relationships between age, gender, and social class were tested. DESIGN: A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire. SETTING: General populations in two Swedish primary health care districts. Medical care was provided in a state health system. SUBJECTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1,806). The response rate was 90%. OUTCOME MEASURES: Descriptive epidemiologic data in relation to objectives of the study. RESULTS: Without sex differences, 55% (95% confidence interval, 53-58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. CONCLUSION: Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.

Adult↗
PubMed1998

Skeletal muscle abnormalities in patients with fibromyalgia.

Widespread muscle pain and tender points are the most common complaints of fibromyalgia patients, and the underlying mechanisms responsible for these symptoms have been studied intensively during the past decade. It has been suggested that fatigue and pain may lead to decreased levels of physical activity in many patients. The resulting deconditioned state may itself contribute to muscle abnormalities. Associated symptoms such as disturbed sleep, anxiety, depression, or irritable bowel also may have a negative impact on muscle function and level of daily activities. The important interactions between the central nervous and musculoskeletal systems may involve another element, the neuroendocrine stress-response system. This review will consider both the current state of knowledge and also future studies which might be designed to answer more effectively the outstanding questions regarding the underlying pathogenesis of fibromyalgia.

Adenosine Triphosphate↗
PubMed1989

Pediatric head injury caused by off-road vehicle accidents.

Morbidity and mortality from pediatric head injuries associated with the use of off-road vehicles are increasing. We reviewed all such injuries admitted to acute care hospitals in the two largest urban centers in Manitoba between April 1979 and August 1986. Of 375 injured children, 83 suffered head injury, 70 boys and 13 girls. Ages ranged from 2 to 15 years, with a mean of 10.4 years. Head injury was defined as any injury involving face, scalp or nervous system. Dirtbikes were implicated in 34 accidents, snowmobiles in 28, 3-wheel ATV's in 19, and 4-wheel ATV's in 2. About 85% of accidents occurred in a rural setting. Loss of vehicle control was the most common cause of injury. Alcohol or drug abuse were not factors. Fifty (60.2%) patients suffered loss of consciousness, prolonged in 6 (7.2%). All head-injured children also suffered at least one associated injury, mainly involving the musculoskeletal system. Associated spinal injury occurred in 18%. The average hospital stay was 13 days. Three (3.6%) patients died as a result of head injury.

Accidents↗
PubMed2000

Recognition of common childhood malignancies.

Although cancer has an annual incidence of only about 150 new cases per 1 million U.S. children, it is the second leading cause of childhood deaths. Early detection and prompt therapy have the potential to reduce mortality. Leukemias, lymphomas and central nervous system tumors account for more than one half of new cancer cases in children. Early in the disease, leukemia may cause nonspecific symptoms similar to those of a viral infection. Leukemia should be suspected if persistent vague symptoms are accompanied by evidence of abnormal bleeding, bone pain, lymphadenopathy or hepatosplenomegaly. The presenting symptoms of a brain tumor may include elevated intracranial pressure, nerve abnormalities and seizures. A spinal tumor often presents with signs and symptoms of spinal cord compression. In children, lymphoma may present as one or more painless masses, often in the neck, accompanied by signs and symptoms resulting from local compression, as well as signs and symptoms of systemic disturbances, such as fever and weight loss. A neuroblastoma may arise from sympathetic nervous tissue anywhere in the body, but this tumor most often develops in the abdomen. The presentation depends on the local effects of the solid tumor and any metastases. An abdominal mass in a child may also be due to Wilms' tumor. This neoplasm may present with renal signs and symptoms, such as hypertension, hematuria and abdominal pain. A tumor of the musculoskeletal system is often first detected when trauma appears to cause pain and dysfunction out of proportion to the injury. Primary care physicians should be alert for possible presenting signs and symptoms of childhood malignancy, particularly in patients with Down syndrome or other congenital and familial conditions associated with an increased risk of cancer.

Bone Neoplasms↗
PubMedDate not supplied

Marfan's syndrome with aortic valve endocarditis.

Marfans syndrome is an Autosomal dominant disorder of the connective tissues resulting in abnormalities of the musculoskeletal system, cardiovascular system and eyes. It has a prevalence of 1 in 100,000 population1 and occurs in all ethnic groups. It may be familial or due to new mutation (30%), in the fibrillin gene on arm of chromosome 15. It is estimated that one person in every 3000-5000 has Marfans syndrome may have cardiovascular abnormalities and may be complicated by infective endocartditis. About 90% of Marfan patients will develop cardiac complications2. The patient under discussion has musculoskeletal (Tall stature, reduced upper-lower segment ratio, arm-span to height ratio > 1.05, high arched palate) and Cardiovascular features (Severe aortic regurgitation complicated with infective endocarditis).

Adult↗
PubMed2006

Biomaterials-based tissue engineering and regenerative medicine solutions to musculoskeletal problems.

Tissue engineering and regenerative medicine offer solutions to a number of compelling clinical problems that have not been adequately addressed through the use of permanent replacement devices. The challenge will be to select the optimal combination of a biomaterial scaffold, cells, and soluble regulators for a particular clinical problem. For many connective tissues of the musculoskeletal system, with microstructures that reflect the mechanical environment, it may be more advantageous to regenerate the tissue (in such a way that they retain their phenotypic characteristics) and in the genetic engineering that has led to the production of growth factors and cloning of their genes.

Biocompatible Materials↗
PubMed2006

Pain and musculoskeletal pain syndromes related to computer and video game use in adolescents.

The objective of the present study was to evaluate the presence of pain and musculoskeletal pain syndromes in adolescents and associate them to computer and video game use. A cross-sectional study was performed on the entire adolescent population (n=833) of a private situated in the city of São Paulo. The research included a questionnaire and physical examination of the musculoskeletal system. Statistical analysis was carried out with Fisher, chi-square, Mann Whitney tests and logistic regression. A total of 791 adolescent was evaluated. A computer was used by 99% and video games by 58%. Pain was reported by 312 (39.4%) students: 23% complained of back pain, 9% of upper limb pain, 4% of diffuse pain and 4% of pain in the trapezium muscle. A clinical examination was carried out in 359 students, and one or more musculoskeletal pain syndromes were present in 56 students (15.6%): benign joint hypermobility syndrome in 10%, myofascial syndrome in 5%, tendonitis in 2% and fibromyalgia in 1%. In the multivariate analysis, the logistical regression showed that the independent variables in the prediction of pain were sex [odds ratio (OR): 2.19, 95% confidence interval (95% CI): 1.33-3.61] and age (OR: 1.17, 95% CI: 1.07-1.28) and that the prediction of musculoskeletal pain syndromes were sex (OR: 3.17, 95% CI: 1.69-6.22) and number of days a week using the computer (OR: 1.22, 95% CI: 1.05-1.42). However, the variations in the dependent variables by the mathematical regression models were low. Despite the frequent use of computer and video games among adolescents, this was not associated with the presence of pain and musculoskeletal pain syndromes.

Adolescent↗
PubMed1993

[Magnetic resonance tomography using the fast STIR technique: optimization and a comparison with other sequences in a 0.5-Tesla system].

One disadvantage of the STIR sequence in MRI is its long acquisition time. A TR shortening for acceleration requires shortening of the inversion time depending upon the field strength. We optimized this "fast-STIR" technique at 0.5 T using calculations, phantom, volunteer, and patient measurements. This optimization procedure is transferable to other field strengths. The resulting sequence takes 4.5 minutes, fat is visualised signal-free. In the second part of our study we compared quantitatively and qualitatively the signal intensities, contrast, and sensitivity towards artifacts of this sequence with that of conventional SE and GRE sequences in 21 patients with neoplastic, inflammatory and traumatic disorders of the musculoskeletal system. The fast-STIR sequence showed similar or better lesion contrast as SE in 100% and as GRE in 88%. Decreased spatial resolution and higher sensitivity towards pulsatile artifacts of the fast-STIR sequence were only minor drawbacks.

Achilles Tendon↗
PubMed1988

Musculoskeletal tumors: T1 and T2 relaxation times.

The T1 and T2 relaxation times of primary tumors of the musculoskeletal system were calculated in 54 patients. No correlation was found between the relaxation values and the histopathologic type of the tumors. Lipoma had the same relaxation characteristics as normal fat. Otherwise tumors could be differentiated from normal tissue, but there was no significant difference between malignant and benign tumors, and the mean values for the different histopathologic types differed significantly only in a few instances. Hence T1 and T2 measurements are of limited value for histologic characterization of musculoskeletal tumors.

Bone Neoplasms↗
PubMed2003

Current status of outcome measure development for clinical trials in systemic sclerosis. Report from OMERACT 6.

Systemic sclerosis (SSc), also known as scleroderma, is a complex, multisystem disease that results in severe morbidity, disability, and life-threatening complications. The wide range of biological systems clinically involved, and the large spectrum of disease activity and damage that occurs in this disease have limited clinical investigation of SSc, especially therapeutic trials. The OMERACT 6 Workshop on Systemic Sclerosis was conceived as a starting point for the process of assessing the current state of the science in outcome assessment in SSc and then setting a realistic research agenda and priorities for future work in this area This article reviews the current status of assessment tools for research in SSc within the main fundamental domains of illness in SSc, including problems related to skin, pulmonary, cardiac, peripheral vascular (Raynaud's phenomenon and digital ulceration), renal, and musculoskeletal systems as well as health-related quality of life and physical functioning. The current level of validation of outcome measures in SSc is assessed according to the guidelines set forth by prior OMERACT meetings.

Clinical Trials as Topic↗