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PubMed2005

[A new 2D and 3D imaging approach to musculoskeletal physiology and pathology with low-dose radiation and the standing position: the EOS system].

Close collaboration between multidisciplinary specialists (physicists, biomecanical engineers, medical radiologists and pediatric orthopedic surgeons) has led to the development of a new low-dose radiation device named EOS. EOS has three main advantages: The use of a gaseous X-ray detector, invented by Georges Charpak (Nobel Prizewinner 1992), the dose necessary to obtain a 2D image of the skeletal system has been reduced by 8 to 10 times, while that required to obtain a 3D reconstruction from CT slices has fallen by a factor of 800 to 1000. The accuracy of the 3D reconstruction obtained with EOS is as good as that obtained with CT. The patient is examined in the standing (or seated) position, and is scanned simultaneously from head to feet, both frontally and laterally. This is a major advantage over conventional CT which requires the patient to be placed horizontally. -The 3D reconstructions of each element of the osteo-articular system are as precise as those obtained by conventional CT. EOS is also rapid, taking only 15 to 30 minutes to image the entire spine.

Humans↗
PubMed2001

"It was really nice to have someone"--lay people with musculoskeletal disorders request supportive relationships in rehabilitation.

AIMS: To explore the lay person's perspective on the rehabilitation process. METHODS: A total of 20 interviews were conducted with women and men who had recent or more distant experience of sickness absence with musculoskeletal diagnoses. Grounded theory was used, which includes an inductive approach and theoretical sampling. The interviews focused on the individuals' own stories and experiences of factors that promoted or hindered the rehabilitation process. RESULTS: The interviewees emphasized how and by whom they had been treated rather than what type of rehabilitation programmes they had attended. They focused on the importance of supportive relationships from the private. occupational, and health care arenas. The relationship with rehabilitation agents (professionals who implemented rehabilitation) was described as having either supportive or non-supportive qualities. Based on the interviewees' descriptions, a model was developed on the socioemotional qualities of the rehabilitation agent. The most promoting factor in the rehabilitation process was to have a professional mentor that is a rehabilitation agent who combines a supportive approach with individually chosen rehabilitation measures and goals. CONCLUSIONS: The lay person's perspective gave additional knowledge regarding rehabilitation and recovery from musculoskeletal disorders. The socioemotional qualities of the rehabilitation agents were emphasized by the interviewees and a model regarding these qualities was developed. This model needs to be tested further. A clinical implication of the present study is the need for rehabilitation agents to develop their communication skills further.

Adult↗
PubMed1992

Adaptation of cancellous bone to aging and immobilization in growing rats.

Two-and-half-month-old female rats were subjected to right hindlimb immobilization or served as controls for 0, 1, 2, 8, 14, and 20 weeks. The right hindlimb was immobilized by bandaging it against the abdomen, thus unloading it. Cancellous bone histomorphometry was performed on microradiographs and double-fluorescent labeled 20 microns sections of the distal femoral metaphyses. Primary spongiosa bone loss occurred rapidly by 2 weeks, and secondary spongiosa bone loss occurred rapidly by 8 weeks of immobilization, and then equilibrated at 60% less bone mass than age-related controls. The negative bone balance induced by immobilization was caused by transient increase in bone resorption, decrease in bone formation, and longitudinal bone growth. The dynamic data of secondary spongiosa cancellous bone showed that percent eroded perimeter was transiently elevated by 55 to 82% between 1 and 8 weeks, percent labeled perimeter was transiently depressed by 32% to 50% between 1 and 14 weeks, mineral apposition rate was depressed by 23% and 19% at 1 and 2 weeks, and bone formation rate-bone area referent was transiently depressed by 35% and 59% at 1 and 2 weeks. All the above parameters were at age-related control levels by 20 weeks of immobilization. However, bone formation rate-tissue area referent was depressed (-65%) throughout the study. Immobilization depressed completely longitudinal bone growth by 2 weeks and remained so. Only 0.65 mm of new metaphysis was generated in the immobilized versus 2.1 mm in controls during the study period. The immobilization induced an early cancellous bone loss which equilibrated at a new steady state with less bone and a normal (age-related control) bone turnover rate. When these findings were compared to an earlier study of 9-month-old virgin females subjected to right hindlimb immobilization up to 26 weeks, we found the adaptive responses of the cancellous bone were identical except that they occurred earlier and equilibrated sooner in younger rats.

Aging↗
PubMed1998

Bioreactor perfusion system for the long-term maintenance of tissue-engineered skeletal muscle organoids.

Three-dimensional skeletal muscle organ-like structures (organoids) formed in tissue culture by fusion of proliferating myoblasts into parallel networks of long, unbranched myofibers provide an in vivo-like model for examining the effects of growth factors, tension, and space flight on muscle cell growth and metabolism. To determine the feasibility of maintaining either avian or mammalian muscle organoids in a commercial perfusion bioreactor system, we measured metabolism, protein turnover. and autocrine/paracrine growth factor release rates. Medium glucose was metabolized at a constant rate in both low-serum- and serum-free media for up to 30 d. Total organoid noncollagenous protein and DNA content decreased approximately 22-28% (P < 0.05) over a 13-d period. Total protein synthesis rates could be determined accurately in the bioreactors for up to 30 h and total protein degradation rates could be measured for up to 3 wk. Special fixation and storage conditions necessary for space flight studies were validated as part of the studies. For example, the anabolic autocrine/paracrine skeletal muscle growth factors prostaglandin F2alpha (PGF2alpha) and insulin-like growth factor-1 (IGF-1) could be measured accurately in collected media fractions, even after storage at 37 degrees C for up to 10 d. In contrast, creatine kinase activity (a marker of cell damage) in collected media fractions was unreliable. These results provide initial benchmarks for long-term ex vivo studies of tissue-engineered skeletal muscle.

Animals↗
PubMed2004

A case of neurofibromatosis-Noonan syndrome with a central giant cell granuloma.

Neurofibromatosis Type 1 (NF1) is one of the most common autosomal dominant diseases affecting multiple systems including the vascular, skeletal, and central nervous system. Noonan syndrome (NS) is an autosomal dominant genetic disorder, associated with musculoskeletal and skin manifestations. Coexistence of central giant cell lesions in patients with both NS and NF1 were reported in the literature. Development of multiple central giant cell lesions in a patient with a Noonan syndrome has been referred to as Noonan-like syndrome. A few cases with features of NF1 and NS have been termed as NF1-NS. Here, we present a case of so-called NF-NS associated with a central giant cell lesion.

Adult↗
PubMed1998

Follistatin.

Follistatin, a secreted protein is able to bind and neutralise the actions of many members of the Transforming Growth Factor-beta family of proteins. Follistatin was first implicated in the regulation of follicle-stimulating hormone secretion in the pituitary and subsequently in other regions of the adult body associated with reproductive functions. Recent work has shown that this protein is much more broadly distributed and may also play a significant role during embryogenesis. Gene targetting has shown that follistatin is essential for normal development and in its absence, mice die soon after birth with a range of defects including insufficient muscle development and skeletal abnormalities. A number of diseases have been identified thought to be caused by an over-production of members of the Transforming Growth Factor-beta family of proteins. Therefore it may be possible to use follistatin as a therapeutic agent in these disorders.

Animals↗
PubMed2001

A teaching unit in primary care sports medicine for family medicine residents.

The authors describe their experience in setting up a sports medicine teaching unit within a family practice center of a teaching hospital. The unit's patient population more closely resembles that of a typical family practice than that of a traditional musculoskeletal teaching clinic (e.g., orthopedics, emergency room). The teaching program includes direct observation of residents performing history taking and physical examinations through one-way mirrors, close supervision for each case, and a sports therapist who educates patients and residents about home exercise programs when physiotherapy within private clinics is not necessary or affordable. At the end of each session 20-30 minutes are devoted to teaching specific physical examination skills. The authors describe how their clinic interacts with other services within the hospital and how certain obstacles they encountered when setting up the clinic might be avoided by others. They feel that this type of unit complements other existing programs in the family medicine department and provides an excellent learning experience for family medicine residents, who are likely to see a high proportion of patients with muskuloskeletal injuries in their practices.

Clinical Competence↗
PubMed1999

Evaluation of costs in rheumatic diseases: a literature review.

The aim of our review was to examine recently published cost-evaluations presenting originally developed data in rheumatic conditions. We identified 21 articles: 9 presenting original data on rheumatoid arthritis and/or osteoarthritis; 7 focusing on other musculoskeletal conditions such as back pain, scleroderma, Lyme disease, and fibromyalgia; and 5 assessing costs in total knee and hip arthroplasty. Most of the studies originated in the United States. In contrast to earlier reviews in this journal, fewer studies focused on only pharmacoeconomic aspects. In reviewing these studies, we found a lack of standardization in cost-assessment leading to a limited comparability of study results. As main tasks to improve the evidence achieved by performing cost-evaluations in clinical settings, we identified a standardization of main cost-components that should be covered by each clinical trial and the assessment of validity, reliability, and comparability of different data sources used to collect cost-data.

Arthritis, Rheumatoid↗
PubMed2005

Oral retinoids for the prevention of skin cancers in solid organ transplant recipients: a systematic review of randomized controlled trials.

BACKGROUND: The increased incidence of skin cancers after solid organ transplantation is well recognized. Skin cancers developing in transplant recipients are more aggressive in behaviour. Therapeutic options to reduce and/or delay the development of cutaneous neoplasms are therefore of interest. OBJECTIVES: The objective of this review was to summarize the available medical literature from randomized controlled trials on the use of oral retinoids as a preventive agent for skin cancers in the solid organ transplant population. METHODS: Three electronic databases were searched for relevant trials: MEDLINE (1966-October 2003), EMBASE (1980-week 44, 2003) and the Cochrane Controlled Trials Register (third quarter 2003). Randomized or quasi-randomized controlled clinical trials on subjects of any age or ethnic background who had received a solid organ transplant (cardiac, renal, liver, etc.) were evaluated. All titles and abstracts found by the search strategy were independently reviewed by two researchers for inclusion into the review. RESULTS: Eighty-one abstracts were identified through the electronic databases for consideration. Review of the abstracts identified three eligible trials. One cross-over trial involving 23 subjects treated with acitretin 25 mg daily for 12 months reported 46 squamous cell carcinomas (SCCs) developing in six subjects during acitretin treatment vs. 65 SCCs developing in 15 subjects during the drug-free period. Another trial involving 44 subjects treated with acitretin 30 mg daily or placebo for 6 months reported two of 19 subjects developing two SCCs in the treatment group vs. nine of 19 subjects developing 18 new skin cancers (15 SCCs, one Bowen's disease, two basal cell carcinomas) in the placebo group. One dose comparison trial involving 26 renal transplant recipients treated with acitretin did not find a significant difference in numbers of skin cancers developing at the doses examined. The major limitation to the use of acitretin was poor tolerance due to adverse events. Headaches, rash, musculoskeletal symptoms and hyperlipidaemia were the most common causes of withdrawal from treatment. No alterations in renal or liver function were detected during the periods of treatment or follow-up. CONCLUSIONS: The available data from a small number of randomized controlled trials suggest that acitretin may have a role in the management of solid organ transplant recipients with skin cancers. Tolerability of the drug is a major factor limiting its use. Appropriate selection of patients may help improve the risk-benefit ratio.

Acitretin↗
PubMed2000

Hospitalization among workers compensated for occupational asthma.

Occupational asthma (OA) can cause persistent symptoms, but populations with OA have not been followed for the development of serious outcomes such as hospitalization. Subjects receiving compensation for OA during 1980-1993, and a comparison sample of workers with musculoskeletal injuries (INJ) were identified from the Ontario Workers' Compensation Board. We also identified for comparison a group of asthmatic patients (AP) seen at a tertiary care hospital clinic during the same period. The file was matched with the Ontario Ministry of Health data base of hospitalizations through 1996. We compared the frequency of hospitalization of the subgroups with that expected in the general population using standardized morbidity ratios (SMRs), and directly by proportional hazards regression. The study group included 844 OA claimants, 1,556 INJ claimants, and 402 AP. Although admissions for all causes combined and respiratory disease among INJ were less than expected in the general population, admissions for all causes combined exceeded that expected among OA and AP. Admissions for respiratory disease were markedly greater than expected among OA (SMR 9.2) and AP (SMR 17) because of even greater excess admissions for asthma (SMRs 45 and 81, respectively). Compared with those with INJ, those with OA were more likely to be hospitalized for all causes combined (adjusted relative risk [RR] 1.4, 95% confidence interval [CI] 1.2 to 16); cardiovascular disease (RR 1.4, 95% CI 0.9 to 2.0); respiratory disease (RR 5.4, 95% CI 3.8 to 7.7); and asthma (RR 28.1, 95% CI 10.2 to 77.2) but not for malignancies (RR 1.0) or injuries (RR 0.9). Those with OA were admitted to hospital about half as frequently as AP for respiratory disease and asthma (although this was modified by smoking status and sex), but were 30% more likely to be admitted for ischemic heart disease (IHD). Among the OA claimants, factors that were significantly associated with hospitalization for asthma included older age and exposure to agents other than isocyanates. Those with OA became less likely to be hospitalized for asthma with increasing time after onset, particularly after 5 or more years. We conclude that subjects with OA suffer higher rates of hospitalizations for all causes combined, respiratory disease, and asthma than other workers, although less than among AP seen at a tertiary care center.

Adult↗
PubMed2005

Health related quality of life in patients with supination-external rotation stage IV ankle fractures.

BACKGROUND: While open reduction of displaced ankle fractures generally is accepted as the standard of care, relatively little is known about the health related quality of life after treatment. It is generally accepted that clinical results of treatment for supination-external rotation stage IV ankle fractures are favorable. The goal of this investigation was to determine the relationship between clinical results and health-related quality of life outcome measures in a consecutive series of patients treated for closed supination-external rotation stage IV ankle fractures. METHODS: Twenty-six of 156 patients who had operative treatment for closed, displaced supination-external rotation stage IV ankle fractures during a 9-year period, completed the Short Musculoskeletal Function Assessment (SMFA) outcome questionnaire. Radiographs and clinical records were reviewed to determine quality of operative repair, postoperative morbidity, and the development of post-traumatic arthritis. RESULTS: There were no postoperative complications. Of the 26 patients who returned the SMFA questionnaires, 19 had "good," and seven had "fair" reduction of their fractures. Six showed radiographic evidence of arthritis at followup. Study participants reported scores that were similar to the general population in five of the six domains of the SMFA. Their scores in the mobility index were statistically less favorable (23.72 vs. 13.61, p = 0.016) when compared to the general population. Participants with "good" operative reductions and no evidence of arthritis at followup showed no significant difference to the general population. Participants with either a "fair" operative reduction or evidence of postoperative arthritis at followup had less favorable scores in the daily activities (mean 13.45 vs. 11.82, p = 0.004), mobility (43.43 vs. 13.61, p = 0.001), dysfunction (32.89 vs. 12.70, p = 0.014), and bother (35.80 vs. 13.77, p = 0.020) domains, when compared to the general population. CONCLUSIONS: The results of this investigation suggest that patients with excellent radiographic operative reductions and no arthritis as early as 6 months after surgery sustain no lasting unfavorable effect on health related quality of life. Patients with "fair" radiographic reduction, or presence of arthritis or both at followup, are likely to have a negative effect on their quality of life.

Activities of Daily Living↗
PubMed2003

The effectiveness of back pain and injury prevention programs in the workplace.

Musculoskeletal disorders in the workplace cause thousands of injuries and cost industry billions of dollars yearly. Work injury prevention programs have been developed and implemented as a means for cost containment. A variety of preventive strategies have been investigated in primary research. The purpose of this review article is to examine the effectiveness of back injury and pain prevention programs in the workplace. Nine studies published between 1995 and 2000 were reviewed and analyzed. Studies used primarily one of three types of preventive strategies: 1) back belts, 2) education and task modification, and 3) education and task modification with workstation redesign. The effectiveness of back belts to prevent back pain and injury remains inconclusive. Positive outcomes were associated with studies reporting high compliance that used job-specific and individualized/small group education and training approaches. Themes that arose following a critical review of primary research studies are discussed.

Back Injuries↗
PubMed2005

Orthopedic management of hemophilia.

Hemophilia is an X-linked inherited bleeding disorder characterized by a deficiency of clotting factor VIII or IX in the intrinsic pathway of the coagulation cascade. This disease can have a profound, debilitating effect on the musculoskeletal system through recurrent hemarthroses and intermuscular hematomas. Although medical management with replacement factor is often effective, patients with severe hemophilia may develop chronic synovitis and arthropathy best treated with more invasive means. Radioactive synovectomy performed at select hemophilia centers and arthroscopic or open synovectomy are helpful for chronic, active synovitis. Arthroplasty helps improve function and pain relief for most patients, but complication rates, particularly for infection, are higher than those for arthroplasty performed on patients without hemophilia.

Acute Disease↗
PubMed1988

Biomechanics of the human spine and trunk.

This chapter has reviewed the past 30 years of experimental biomechanical studies of the spine and trunk. In the last 10 years, computers have allowed the development of simulation techniques and models to predict spine and muscle loading in most static and quasi-static activities. Some problems remain, however, particularly with activities involving bending and twisting and those that entail maximal efforts. Current research is focused on trying to validate models for the analysis of dynamic activities involving simple planar motions. Although the body segment kinematics and external support forces in complex motions can be measured fairly easily with modern motion analysis equipment, models that correctly predict the internal trunk forces have yet to be fully developed and validated. These models will be useful in studying how, why, and where failure of the soft and bony tissues is most likely to occur in a given activity, and whether it is related to work or athletics. The challenge for the future is to develop models that adequately reflect the anatomical sophistication of the spine and trunk. Thus the stress and strain distributions in any trunk musculoskeletal component, whether the posterior wall of the annulus, a muscle slip of the semi-spinalis group, or the lumbosacral endplate, will be able to be found. These results can then be combined with models of cumulative trauma response to successfully identify potential failure sites.

Aging↗
PubMed1993

Prevention, clinical, and pathophysiological research on vibration syndrome.

In the 1950s, introduction of portable power tools into the production process of many industries began on a large scale around the world and resulted in many cases of occupational vibration syndrome after the 1960s. There was an urgent need to undertake preventive steps, medical assessment and therapy throughout the world. At the end of 1964, our investigation began in Japanese national forests, and then in mining and stone quarries. Our research and efforts resulted in a comprehensive system for prevention of vibration syndrome in the Japanese national forest industry. It has presented a good model of prevention for other industries in Japan. Clinical and pathophysiological research on vibration syndrome in the 1960s and 1970s clarified disturbances of the peripheral circulatory, nervous, and musculoskeletal systems. From the mid-1970s, neurophysiological, neurochemical, and clinical research on vibration syndrome in relation to the autonomic nervous system developed. Our studies contributed to the advancement of research in this field. More in-depth study is needed to determine the role of the autonomic nervous system in vibration syndrome.

Humans↗
PubMed2006

[Computed tomography of the musculoskeletal system].

Computed tomography (CT) is an important diagnostic modality in the work-up of musculoskeletal diseases. Just as projection radiography and magnetic resonance imaging, it has specific possible uses. As a tool to guide interventional and surgical procedures, it is a significant imaging technique. The technical development of multislice spiral CT in recent years has contributed considerably to increasing the diagnostic quality of CT. In particular, the possibilities for depicting the findings with methods for secondary image reconstruction have been decidedly improved.

Bone Diseases↗