Significance of arthrography and computed tomography in the assessment of internal derangement of the temporomandibular joint

Arthrography was performed on 56 joints of 47 patients presenting with symptoms of pain and dysfunction of the temporomandibular joint. The diagnosis could be confirmed in 53 joints. In addition, there was evidence of 13 perforations and 7 joints with adhesions. In 51 of the affected joints, computed tomography (CT) was also performed to compare both methods. The same CT procedure was performed on 12 joints of patients without any joint problem. Almost consistently (88%), an arthrographically anteriorly dislocated disc was detectable in the axial CT scans. 92% of the healthy joints showed normal soft tissue structures. For CT visualization of a displaced disc sagittal reformations or primary sagittal scans are not necessary. Confirmation of possible perforations or adhesions cannot be made by CT. Comparing the advantages and disadvantages, arthrography must still be regarded as superior to CT. In some cases, however, CT is a valuable tool in assessing an internal derangement.

Ultrasonography of inflammatory soft tissue swellings of the head and neck

Experience with 107 B-scan sonographs of inflammatory soft tissue swellings of the head and neck is described, and an echomorphologic classification is proposed which consists of the following five types: edema, infiltrate, preabscess, echo-poor, and echo-free abscess. Because the clinical course of the symptoms differs significantly between the last three types, it was concluded that they represent different stages of abscess formation. A comparison of all the physical and sonographic diagnoses showed only slightly higher sensitivity for sonography. However, with regard to the specific diagnosis of abscess, the sonographic examination seemed to be superior to the clinical diagnosis.

Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients

Myofascial pain syndrome (MPS) is a common but misunderstood muscular pain disorder involving pain referred from small, tender trigger points within myofascial structures in or distant from the area of pain. Misdiagnosis or inadequate management of this disorder after onset may lead to development of a complex chronic pain syndrome. A review of the clinical characteristics of 164 patients whose chief complaints led to the diagnosis of MPS revealed that these patients had (1) tenderness at points in firm bands of skeletal muscle that were consistent with past reports, (2) specific patterns of pain referral associated with each trigger point, (3) frequent emotional, postural, and behavioral contributing factors, and (4) frequent associated symptoms and concomitant diagnoses.

Chemical characterization of a rabbit leukocytic pyrogen

Crude pyrogen was obtained by stimulating 1.4 x 10(12) peritoneal-exudate leukocytes from rabbits in vitro with Escherichia coli endotoxin. A pyrogen molecule was isolated by ammonium-sulfate precipitation, polyacrylamide gel electrophoresis at pH 5.5 and 8.9, and gel filtration on Bio-Gel P-100. These procedures yielded a pyrogenic fraction which was electrophoretically and immunologically homogeneous. The pyrogenicity was 50 ng/kg of rabbit. This leukocyte pyrogen consisted of a protein with a molecular weight of approximately 14 000. Amino-acid analysis showed high amounts of glutamic acid and glycine; methionine and tryptophan were present in small quantities. Arginine was found to be the N-terminal amino acid. The molecule contained about 0.8% neutral sugar and 0.7% lipids. Its approximate isoelectric point in citrate/phosphate buffer was 4.2. The activity was lost by lyophilization and storage at - 18 degrees C for six months. The data presented here are the first detailed characterization of a rabbit leukocyte pyrogen. The properties in common to leukocytic pyrogen and interleukin 1 are discussed.

[Left ventricular relaxation and filling abnormalities in patients with HOCM and left ventricular pressure overload (author's transl)]

In order to test the hypothesis that delayed mitral valve opening (MO) with regard to endsystolic dimension (t DS-MO) is specific for hypertrophic obstructive cardiomyopathy (HOCM), LV echograms of patients with different forms of LV hypertrophy due to chronic pressure overload (CPO; aortic stenosis + arterial hypertension, n = 24) and hypertrophic obstructive cardiomyopathy (n = 24) were recorded, digitized and compared with those of normals (N :n = 28(. In patients with HOCM (93 +/- 37 ms; p less than 0.0001) and CPO (66 +/- 31 ms; p less than 0.0001) the time t DS-MO was significantly delayed compared with N (13 +/- 15 MS), due to abnormal relaxation. This prolonged relaxation time resulted in an abnormal diameter increase (delta D) during the isovolumic relaxation phase (HOCM: 4.0 +/- 2.2 MM/CPO: 3.0 +/- 1.8 mm; p less than 0.0001/N:0.6 +/- 0.5 mm) and the rapid filling phase (HOCM 7.6 +/- 2.7 mm; p less than 0.0001/CPO 9.2 +/- 2.9 mm; p less than 0.05 / N: 10.7 +/- 2.2 mm). The echocardiographical signs of an abnormal relaxation are not specific for HOCM, they can be seen in different forms of secondary LV hypertrophy and are accompanied by changes in the diastolic filling pattern.

[Vaccination complications after oral poliomyelitis vaccination (author's transl)]

A vaccination complication is only to be recognized if, taking into consideration the incubation time, the clinical picture coincides with that of spontaneous poliomyelitis. Apart from exceptional cases, virological studies are only of importance for the assessment if they are carried out in the acute or subacute stages. Only six out of more than 150 cases could be accepted as vaccination complications.

Mechanism of fever induction in rabbits

Three exogenous pyrogens (Escherichia coli lipopolysaccharide, synthetic double-stranded ribonucleic acid. Newcastle disease virus) were compared with respect to their mechanisms of fever induction in rabbits. All inducers stimulated the production of an endogenous pyrogen demonstrated in the blood as well as prostaglandins of the E group, and of cyclic adenosine 3',5'-monophosphate in the cerebrospinal fluid. The concentrations of these compounds were elevated approximately twofold as compared to the controls. Independently of the mode of induction, the fever reaction could be prevented by pretreatment with 5 mg of cycloheximide per kg, although the three fever mediators were induced as in febrile animals. Consequently, at least one additional fever mediator that is sensitive to a 30 to 50% inhibition of protein synthesis by cycloheximide has to be postulated. The comparable reactions of the rabbits after administration of different pyrogens argues for a similar fever mechanism. In contrast to fever induction there was no stimulation of endogenous pyrogen, prostaglandins of the E group, and cyclic adenosine 3',5'-monophosphate in hyperthermia as a consequence of exposure of the animals to exogenous overheating. Furthermore, hyperthermia could not be prevented by cycloheximide.

Prostaglandins in cerebrospinal fluid of patients during various infectious diseases

Concentrations of prostaglandins of the E and F series were estimated by radioimmunoassay in cerebrospinal fluid (CSF) of 30 febrile patients (infants and adults) and of 19 afebrile, adult patients. In CSF of all feverish patients with meningitis, pneumonia, or pyelonephritis, concentrations of prostaglandins of the E series were about twice higher than those of the afebrile subjects. In contrast, concentrations of prostaglandins of the F series remained largely unchanged during fever. In accord with the results of animal experiments prostaglandins of the E series seem to act as mediators of fever during infectious diseases also in man.

Inhibition of Newcastle disease virus-induced fever in rabbits by cycloheximide

Pretreatment with cycloheximide prevents virus-induced fever in rabbits. Compared to the febrile control animals, CH-pretreated afebrile animals exhibit similar concentrations of endogenous pyrogen in the blood and of prostaglandins of the E-group and adenosine 3', 5'-cycle monophosphate in the cerebrospinal fluid. The fever response seems to involve one or several additional so far unknown mediators which are sensitive to cycloheximide.

Adenosine 3',5'-cyclic monophosphate in rabbit cerebrospinal fluid during fever induced by E. coli-endotoxin

In rabbit cerebrospinal fluid during fever induced by E. coli-endotoxin adenosine 3',5'-cyclic monophosphate concentrations are about 2-fold higher in comparison to normal values. In addition to prostaglandins of the E series adenosine 3',5'-cyclic monophosphate might act as another mediator in the genesis of fever during infectious diseases.

Plasma prostaglandins of the E and F series in rabbits during fever induced by Newcastle disease virus, E. coli-endotoxin, or endogenous pyrogen

Prostaglandins of the E and F series in rabbit plasma were estimated by radioimmunoassay after chromatographic separation during fever following the intravenous injection of Newcastle disease virus, E. coli-endotoxin, or endogenous pyrogen. Although concentrations of prostaglandins from both series are increased considerably by the three pyrogens, there seemed to be no correlation between prostaglandin concentrations in plasma and body temperature. These findings were supported by the fact, that after the injection of tritiated prostaglandin E1 into the carotid arteries of normal or feverish animals no radioactivity was detectable in cerebrospinal fluid. The enhanced prostaglandin concentrations in plasma night be responsible for various pathological effects observed during fever such as diarrhoea and abortion.

Pyrogenic principle of the ribonucleic acid from the yeast Candida utilis

Experiments were performed to characterize the pyrogenic principle of ribonucleic acid (RNA) from the yeast Candida utilis. It was shown that ribonuclease hydrolysis of the RNA does not lead to inactivation of the pyrogenicity. Pyrogenicity was, however, destroyed by treatment with sodium deoxycholate. On column chromatography with Biogel under sterile and pyrogen-free conditions, the pyrogenic principle of yeast RNA was eluted together with the RNA. After treatment of the RNA with ribonuclease, it was possible to separate the pyrogenic activity from the RNA (hydrolysis products) to a great extent. Column chromatography of Escherichia coli endotoxin showed that the endotoxin was eluted in the same fractions as the pyrogenic activity of yeast RNA. On the basis of the behavior of the pyrogen, it may very well be that the fever reaction is produced not by the nucleic acid but by pyrogenic contaminants of the RNA preparation.