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PubMed1989

Turnover and metabolism of hyaluronan.

The highest concentrations of hyaluronan occur in synovial fluid, vitreous body, skin and certain specialized tissues such as umbilical cord and rooster comb, during fetal development, and in tissue repair and regeneration. The largest amounts are found in the intercellular matrix of skin and musculoskeletal tissues. Turnover in the bloodstream is normally in the range of 0.3-1.0 microgram min-1/kg body weight. Circulating hyaluronan is mostly derived from lymph. Lymph nodes may nevertheless extract as much as 80-90% from peripheral lymph before it can reach the bloodstream. Turnover in peripheral tissues may be effected by degradation in situ, or by transfer into lymph by diffusion or hydrodynamic forces. Hyaluronan is firmly bound in specific association with cells or binding proteins but much of it exists in freely mobilized compartments with a half-life of two days or less, and it is metabolized after transport elsewhere. Metabolic degradation of hyaluronan is principally intracellular and relies on uptake by a receptor which, in contrast with other hyaluronan-binding structures, also binds chondroitin sulphate. It is suggested that this dual specificity may be primarily associated with metabolic degradation of hyaluronan. Uptake and metabolism are primarily effected in liver and lymph node by endothelial cells lining the sinusoids of each. Further studies indicate that in lymph nodes and in spleen, macrophage-like cells intertwined with the endothelial cells also take up hyaluronan. The metabolic cycle from polymer to monosaccharides, acetate and beyond can be completed in vivo within 10 minutes.

Animals↗
PubMed1994

[Chronic diseases in immigrants from Russia (CIS) at a primary care clinic and their sociodemographic characteristics].

397 new immigrants to Israel ("olim") were under medical treatment at a primary care clinic during the first year (1990-1991) after their immigration to Israel ("aliyah") from 14 republics of the Commonwealth of Independent States (CIS, formerly the Soviet Union). Most of the olim were between 1-19 years of age. More than three-quarters were married and about a third of the women were widowed or divorced. The other patients were bachelors, separated men or women, or divorced men. More than a third had 16 years or more of education. More than a third of the families consisted of 2 members, while more than three-quarters had both parents, and about a quarter only 1 parent, usually the mother. Half the families had children; more than a quarter of the adults had not been employed in the CIS, while in Israel 58.8% were. 464 diagnoses of chronic diseases had been made in the CIS, (1.2/person), of which 75% were verified in Israel. 185 cases (0.5/person) not previously reported were diagnosed or had developed in Israel. The most frequent were cardiovascular, and next digestive tract disease, followed by endocrine, metabolic and musculoskeletal-connective tissue diseases. The overall prevalence rate of ischemic heart disease among men aged 20 < or = 65 years was 18.8%, compared to 5.8% among veteran Israelis. Among women the rates were 9.5% and 4.0%, respectively. The prevalence of hypertension (> or = 160/95) was 14% among men and 21% among women; in veteran Israelis it was 14% for both men and women. The prevalence of diabetes among men was 4.1%, and 5.4% among veteran Israelis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Sternocostoclavicular hyperostosis].

The syndrome of synovitis, acne, pustulosis, hyperostosis and osteomyelitis (SAPHO syndrome) includes disorders with common clinical and radiological manifestations. One of these, sternocostoclavicular hyperostosis, is characterized by inflammation and ossification of ligaments, bones and joints in the upper anterior parts of the trunk. The author reports the case of a 20 year-old female who developed unilateral sternocostoclavicular hyperostosis and complete ankylosis of the second, third and fourth lumbar vertebrae. Prior to onset of musculoskeletal complaints, she experienced a brief episode of dermatitis of the scalp, accompanied by transient alopecia. The condition was controlled by administration of ketoprofen and naproxen.

Adult↗
PubMed1996

[Interactive atlas with magnetic resonance on CD-ROM for Macintosh].

Computer assisted education in radiology has been increasingly used during the past ten years and now complements traditional learning resources. Magnetic Resonance Imaging (MRI) of musculoskeletal anatomy, and particularly of joints, lends itself naturally to learning modules on computer. This paper describes the design, development and use of an interactive computer assisted teaching module of MR joint anatomy on CD-ROM for Macintosh: to date, we have used this atlas for ankle and elbow anatomy. The atlas is divided into three main sections: MR anatomy, traditional anatomy and a quiz. On each MR image, any anatomical detail can be identified clicking on it with the mouse. Buttons allow to visualize cross-reference points and to go directly on the desired image. If the student wants to look at anatomical drawings of the last identified structure, a button retrieves all the cards in the traditional anatomy section containing that structure. Finally, the student can make his own self-assessment, verifying his learning immediately with the exam mode: the software makes a random selection of 10 MR images where an anatomical structure must be indicated: if the answer is wrong, the software gives the right one and shows the misinterpreted structure. Then, the student is given a total score for his performance. The computer assisted teaching modules present some advantages: the images can be viewed in a given sequence (like traditional learning resources) or in any self-paced, customized way; this possibility, together with the friendly interface of Macintosh computers could make learning more active and pleasant.

Anatomy↗
PubMed2005

Advances that are changing the diagnosis and treatment of malignant bone tumors.

PURPOSE OF REVIEW: Several neoplastic conditions may affect bone. These include primary bone tumors as well as metastatic disease from distant primary sites. Often, these entities produce symptoms that may be difficult to distinguish from those of various rheumatologic entities. The purpose of this review is to discuss recent developments in orthopedic oncology, with special attention given to advances that are changing the diagnosis and treatment of bone sarcomas and carcinomas metastatic to bone. RECENT FINDINGS: Much effort in the field of musculoskeletal oncology has been dedicated to the elucidation of the molecular mechanisms underlying bone sarcomas, especially in the case of osteogenic sarcoma and Ewing family tumor. Telomere maintenance mechanisms are emerging as potential targets for anticancer therapy. The most exciting advances have been in the development of novel treatments for cancers affecting bone. The anticancer effects of bisphosphonates, cyclooxygenase-2 inhibitors, and statins may expand their indications to the treatment of primary bone tumors. Finally, new expandable implants have been developed for the treatment of bone tumors in growing children. These devices may help solve some of the problems encountered with reconstruction of the growing skeleton. SUMMARY: Recent discoveries in the molecular mechanisms of bone sarcomas may help to elucidate the pathogenesis of these rare diseases. This, combined with the recent findings of the anticancer effects of bisphosphonates, cyclooxygenase-2 inhibitors, and statins, may lead to the development of novel treatments for sarcomas of bone and of carcinomas metastatic to bone.

Antineoplastic Agents↗
PubMed2002

Clinical oncological applications of Positron Emission Tomography (PET) using fluorine-18-fluoro-2-deoxy-D-glucose.

Positron emission tomography (PET) has initially developed as a research tool, primarily for cardiological and neurological application. In the past decade, the paramount clinical potential of this imaging procedure has been recognized, reaching its full expression in the oncological field. The number of scientific publications demonstrating the clinical accuracy of the tracer [fluorine-18]-fluoro-2-deoxy-D-glucose ([18F]FDG) in the diagnosis, grading, staging, monitoring the response to treatment and in prognostic stratification of the oncological patient is continuously expanding. Nowadays, the clinical use of PET with [18F]FDG is approved in the majority of the countries (even in those with strict health regulations) for the metabolic imaging of proliferative diseases of the lung, breast, colon, and for the adequate diagnostic and prognostic evaluation of the patient with lymphoma and melanoma. Encouraging results have been also obtained in cancers of the head and neck, ovary and musculoskeletal system. Although about 90% of clinical investigations in oncology are performed using [18F]FDG as the tracer, radiopharmaceutical research is continuously developing new and more specific tumor targeting agents, whose efficacy is being explored more and more in the wide scale.

Fluorodeoxyglucose F18↗
PubMed2005

Jaw tracking devices--historical review of methods development. Part I.

Chewing or mastication is one of the main functions of the stomatognathic system. The use of devices for quantitatively measuring mandibular motion has recently become more common in scientific and clinical use. Often, the goal has been to provide an objective basis for diagnosing musculoskeletal disorders of the jaws, to monitor the progress of active treatment methods or to evaluate prosthodontic treatment functional results. To better understand differences between various systems to record mandibular motion a review of recording methods presented over the years was made. To give fundamental description for development of existing methods review was divided in three parts. Part I includes analyses of methods using mechanical devices, photographic methods and roentgenographic methods, describing not only technologies by themselves, but also analyzing essential limitations, possible direction of the functional improvement and, specially, their scientific and clinical significance.

Dental Equipment↗
PubMed1997

[Sports in patients with systemic inflammatory musculoskeletal diseases].

Local and systemic inflammatory mechanisms and immobilisation, perhaps secondarily intensified by corticosteroid treatment, very often produce reduced load capacity of the tissues. Pain, swelling of the joints, muscular atrophy and instability favour such development. Increased activity of the disease rapidly leads to general discomfort and unfitness. Drugs generally help to reduce the inflammatory activity. To increase and restore the musculo-skeletal load capacity, however, the patient must undergo physiotherapy and exercises adapted to the disease activity and, if he/she so desires adequate sporting activity.

Female↗
PubMed2003

Melanocortin-4 receptor messenger ribonucleic acid expression in rat cardiorespiratory, musculoskeletal, and integumentary systems.

We determined melanocortin-4 receptor (MC4-R) mRNA ontogeny in the rat using in situ hybridization and a rat MC4-R riboprobe and showed numerous peripheral sites of expression for MC4-R. The developing heart showed MC4-R mRNA expression as early as embryonic day (E) 14. In the lungs of E16-E20 fetuses, the cells surrounding developing bronchi expressed relatively strong in situ signal. Muscles associated with the respiratory system such as diaphragm and intercostal muscle expressed MC4-R mRNA as early as E14. Occipital and tongue muscles, in particular the genioglossus, showed diffuse signal at E15-E20. In the eye, a discrete signal was detected in an outer neuroblastic layer which may correspond to retina or extraocular muscle. Developing limb buds expressed relatively strong signal at E14, whereas skull bone and joint capsules of the paw of the forelimb showed signal at E18-E20. Using RT-PCR and ribonuclease protection assays, we determined that MC4-R mRNA is also expressed in adult rat heart, lung, kidney, and testis. The expression of the MC4-R in cardiorespiratory, musculoskeletal, and integumentary systems supports functional roles for the MC4-R in addition to its roles in appetite, weight control, and regulation of linear growth.

Animals↗
PubMed2005

Jaw tracking devices--historical review of methods development. Part II.

Chewing or mastication is one of the main functions of the stomatognathic system. The use of devices for quantitatively measuring mandibular motion has recently become more common in scientific and clinical use. Often, the goal has been to provide an objective basis for diagnosing musculoskeletal disorders of the jaws, to monitor the progress of active treatment methods or to evaluate prosthodontic treatment functional results. To better understand differences between various systems to record mandibular motion a review of recording methods presented over the years was made. To give fundamental description for development of existing methods review was divided in three parts. Part II includes analyses of electronic and telemetric methods, magnetometry and opto-electronic methods, describing not only technologies by themselves, but also analyzing essential limitations, possible direction of the functional improvement and, specially, their scientific and clinical significance.

Dental Equipment↗
PubMed2003

Craniofacial development: the tissue and molecular interactions that control development of the head.

The molecular cascades that control craniofacial development have until recently been little understood. The paucity of data that exists has in part been due to the complexity of the head, which is the most intricate regions of the body. However, the generation of mouse mutants and the identification of gene mutations that cause human craniofacial syndromes, together with classical embryological approaches in other species, have given significant insight into how the head develops. These studies have emphasized how unique the head actually is, with each individual part governed by a distinct set of signalling interactions, again demonstrating the complexity of this region of the body. This review discussed the tissue and molecular interactions that control each region of the head. The processes that control neural tube closure together with correct development of the skull, midline patterning, neural crest generation and migration, outgrowth, patterning, and differentiation of the facial primordia and the branchial arches are thus discussed. Defects in these processes result in a number of human syndromes such as exencephaly, holoprosencephaly, musculoskeletal dysplasias, first arch syndromes such as Riegers and Treacher-Collins syndrome, and neural crest dysplasias such as DiGeorge syndrome. Our current knowledge of the genes responsible for these human syndromes together with how the head develops, is rapidly advancing so that we will soon understand the complex set of molecular and tissue interactions that build a head.

Animals↗
PubMed2005

Current status of nonsteroidal anti-inflammatory drugs in physiatry: balancing risks and benefits in pain management.

The gastropathy associated with the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain disorders has contributed to significant morbidity and mortality. The distinction between the cyclooxygenase 1 and 2 enzymatic properties lead to the development of selective cyclooxygenase-2 inhibitory NSAIDs with the prospect of reducing NSAID-related gastropathy while maintaining anti-inflammatory properties. Initial studies of the efficacy and safety of the selective cyclooxygenase-2 inhibitors seemed promising. Larger clinical trials were carried out to reinforce the efficacy and safety of the cyclooxygenase-2 anti-inflammatory medications (coxibs). Further analysis of these trials raised concern with regard to both the efficacy and safety of this class of drugs. The most recent clinical trials of the coxibs have demonstrated significant cardiovascular thrombogenic potential, particularly at higher doses. Clinical investigators and regulatory agencies have questioned whether these findings mitigate the efficacy of coxibs and NSAIDs in general in the prophylaxis of colonic polyps, Alzheimer's disease, and more saliently, musculoskeletal pain disorders. This article addresses the current controversy of the efficacy and safety of the coxibs and NSAIDs in general based on recent clinical trials and review by healthcare consortiums. This article also provides guidelines regarding the use of NSAIDs, including the diminishing armamentarium of the coxibs, and the alternative therapeutic options available to the physiatrist in managing musculoskeletal pain disorders.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1985

Musculoskeletal disorders in neonatal foals.

Angular limb deformities are not uncommon in foals. Mild angular deviation due to laxity of supporting soft tissues often resolves spontaneously. However, external splinting or casting may be needed in severe cases or in those that do not resolve. When incomplete ossification of carpal or tarsal bones is the cause of the limb deformity, external support is mandatory to prevent further deformation and abnormal development of the bones. When epiphyseal and metaphyseal abnormalities cause axial deviation, surgical intervention is usually necessary. Circumferential periosteal transection and/or transphyseal bridging are methods used. The choice is dictated by the type and severity of the deformity. Flexor contractures of the forelimb vary greatly in degree and joints affected. Physical therapy combined with intermittent splint application is often successful, but surgical intervention may be necessary in unresponsive cases. Flexor tendon laxity is usually self-correcting but physical therapy, restricted exercise, and splinting may be needed. Rotational abnormalities are easier to correct in the forelimbs than in the hind limbs. Correction is usually accomplished by frequent corrective hoof trimming. Miscellaneous anomalies of the musculoskeletal system may sometimes be amenable to surgical correction, although the potential disadvantages must be carefully considered. Septic arthritis is a frequent sequela to neonatal septicemia and must be treated aggressively and early in its development. Appropriate systemic antibiotics, joint lavage, and rest are indicated. Neonatal osteomyelitis has a poor prognosis and requires prompt, vigorous therapy; even then, growth anomalies of the limb or contiguous septic arthritis may develop and further worsen the prognosis. Early accurate diagnosis and prompt appropriate therapy are vital in treating musculoskeletal disorders in foals, especially when a successful outcome is judged by the animal becoming a functional athlete.

Animals↗
PubMed1994

[Effect of calcitriol, a vitamin D compound, in bone disease associated with distal renal tubular acidosis].

In a 47-year-old female patient distal renal tubular acidosis (dRTA) led to the development of osteomalacia following 13 years of the first episode of hypokalemic respiratory paralysis and 7 years of KHCO3 treatment. In spite of the musculoskeletal disability, intense bone pain and myopathy, the values of serum calcium (Ca++) and phosphorous (P) showed minimal deviation from the normal levels. The bone scintigraphy was the first indicator of the bone disease. As the disease progressed the serum level of alkaline phosphatase increased gradually and 25-hydroxyvitamin-D level decreased and bone scintigraphy showed multiple areas of increased radioisotope uptake. By that time the patient's condition deteriorated severely, she became almost unable to walk. Rocaltrol (calcitriol) therapy led to dramatic clinical improvement and the complete resolution of the laboratory values. When the alkaline therapy of dRTA does not prevent the development of osteomalacia, administration of a modern vitamin-D preparation can result complete healing of the bone disease.

Acidosis, Renal Tubular↗