[Conventional roentgen diagnosis and computed tomography of the temperomandibular joint in myoarthropathy]

Clinical utilization of the high resolution, thin-slice CT (slice thickness: 1 mm) makes it possible to systemize the bony structure changes of the joint correlated with disfunctions. Using this technique total evaluations of this complex can be made. In patients suffering from myoarthropathy, the partially typical changes in both the functional anatomy, as well as in form, structure and topography of specific regions of the joint can be viewed objectively. The alteration process of the temporomandibular joint is considered causal in connection with muscular disfunctions, which often lay the foundation for chronic pain conditions in the regions of the face and head. The broad spectrum of conventional radiographic techniques documents, on one hand, the extremely unfavorable anatomy of the temporomandibular joint with regard to radiography. On the other hand, it also implies a certain amount of diagnostic uncertainty in this region. Comment is made concerning the informational value as well as the limits of the most important radiologic techniques. It is of utmost importance to evaluate the radiographic findings of the temporomandibular joint in myoarthropathies with a clinical functional analysis, which is easy to carry out.

Cardiovascular reactivity to methacholine in normotensives with genetic risk of hypertension

Hemodynamic reactivity to methacholine (0,1 mg/kg bodyweight) was studied in 10 normotensives with genetic risk of hypertension (mean age: 25,4 +/- 2,6 years) in comparison with 8 controls (mean age: 25,0 +/- 2,3 yrs). Due to peripheral vasodilatation this substance led to an initial blood pressure fall which was the same in the investigated and in the control group. In the phase of counterregulation the secondary rise of blood pressure was higher in the group with family history of hypertension. As evidenced by correlation statistical analysis the increases of heart rate and cardiac output were responsible for the rise of systolic blood pressure. The hemodynamic response to methacholine in the group with genetic risk of hypertension has been attributed to a higher sympathetic reactivity.

Basal blood pressure variability and reactivity of blood pressure to emotional stress in essential hypertension

Blood pressure variability under basal conditions and blood pressure reactivity to emotional stress were studied in 38 hypertensives and 13 normotensives. Systolic basal blood pressure variability correlated with systolic blood pressure reactivity. Variability increased with higher basal blood pressure. Thus in the hypertension group the blood pressure variability was greater than in the normotension group. Besides, the hypertension group showed a greater reactivity of systolic blood pressure to emotional stress, too. An influence of age on basal blood pressure, blood pressure variability, and reactivity could be evaluated; but no influence of sex on these parameters was detected. The results indicate that variability and reactivity of blood pressure can be referred to a common central nervous blood-pressure-regulating mechanism. As both parameters are increased in hypertension, a greater lability of blood pressure must be assumed. This greater lability may be attributed to a stronger neurogenic influence or to structural changes of peripheral blood vessels.

Hemodynamics during emotional stress in borderline and mild hypertension

The hemodynamic response to emotional stress (mental arithmetic) was studied in ten borderline and ten mild hypertensives in comparison to ten age-matched normotensives. Due to emotional stress the blood pressure increased in all three groups; its rise was greater in borderline and mild hypertension. After stress, the blood pressure also remained elevated longer in the hypertensive groups. The increased blood pressure reaction was accompanied by a greater rise of heart rate and cardiac output. The increase of cardiac output correlated with the blood pressure elevation. Stroke volume changed in comparison to the pre-stress period only in the mild hypertension group. Total peripheral resistance decreased slightly in all three groups. No significant differences between the groups could be found in regard to stroke volume and total peripheral resistance. The cardiovascular hyperreactivity in early hypertension is attributed to a stronger sympathetic stimulation of the circulation. The hemodynamic pattern indicates an increased beta-adrenergic stimulation of the heart as the main pathological mechanism.

[The effect of beta receptor blockers and diuretics on blood pressure reactivity]

Previous studies showed the importance of the response of blood pressure to emotional stress in essential hypertension. However, it is unclear to what extent the response of blood pressure to emotional stress is influenced by antihypertensive treatment, and especially by beta-blockers. In the present study the influence of antihypertensive treatment with either beta-blockers (beta) or diuretics (D) was compared in two series of experiments on male hypertensives, carried out after 2 weeks (beta, n = 11; D, n = 11) and 1 year of treatment (beta, n = 11; D, n = 9). One of the two drugs was randomly allocated to each patient. In the first series of experiments an ergometric exercise test was also performed (workload depending on age and body surface area, 60-100 W). The two medications caused a similar decrease in basal blood pressure. The response of blood pressure to emotional stress was also the same in both groups, and equal to that in untreated hypertensives. However, the reaction of systolic blood pressure to dynamic exercise was lower in the patients treated with beta-blockers (30.2 +/- 9.5 mm Hg) than in those treated with diuretics (42.9 +/- 12.1 mm Hg; p = 0.013). The effect of antihypertensive treatment on the reactivity of blood pressure therefore cannot comprehensively be tested by means of a single stress test. In terms of controlling the response of blood pressure to stress, beta-blockers are not generally more effective than diuretics, but only in certain situations.

Traffic noise and hypertension: an epidemiological study on the role of subjective reactions

Traffic noise is discussed as a possible risk factor for hypertension. However, no data are available concerning the moderating effect of the subjective reactions and the noise attitudes. In the present epidemiological study the relationship between these subjective factors and blood pressure was investigated separately for the inhabitants of two residential areas. One area had high traffic volumes, resulting in a high sound level (Leq greater than 73 db (A), noisy area); the other was socially comparable but with an essentially low sound level (Leq less than 51 db (A), control area). The relationship between the subjective reactions and blood pressure was checked by analyzing the incidence of treatment for hypertension (n = 919) and by analyzing the change of casual blood pressure after living 2.25 years in the respective residential area in a subgroup of those who had been normotensive (n = 36). The results obtained by either of these approaches indicate that the subjective factors do not modify the risk of hypertension in noisy areas, whereas they seem to be relevant for medium size stimuli. It is concluded that one can physiologically cope with low stimuli, but this is impossible for extreme stimuli. The results suggest also that the subjective reaction to extreme stimuli is strongly biased by attitudes which cannot be related to blood pressure. The family history of hypertension was found to be independent of the subjective reactions to noise.

Cardiovascular reactivity to ergometric exercise in mild hypertension

Cardiovascular reactivity to ergometric exercise was studied on work loads of 60, 80 and 100 W in 16 young and middle-aged males with mild hypertension and 17 normotensive subjects of the same age. The middle-aged hypertensive group showed a stronger rise in systolic blood pressure to a 100-watt work load than the matched normotensive group. Cardiovascular reactivity was not different with work loads of 60 and 80 W, and young hypertensives and normotensives had the same reactions. Thus cardiovascular reactivity to exercise is dependent on both blood pressure and age.

Looking at nurses’ training from a counsellor’s perspective

The current personnel crisis in hospitals has given rise to serious reflections and numerous investigations. Service conditions, salary structures and other issues have been a pet subject of the public media for a long time. One factor is rarely mentioned although it is far more important, namely that nurses need personal support.

The influence of fine surface structures on the osseo-integration of implants

The availability of inert materials like dense, pure Al2O3-ceramic or titanium allows the study of purely biomechanical influences of surface modulations or lacune on the osseo-integration of implants at different locations of the skeleton. The discovery of the "load-line-shadow" phenomenon in lacune of dental implants and the observation of the same effect in the grooves of hip sockets (Lindenhof type) indicate the general validity of the rules controlling the remodelling ability of bony tissue. Their application to the problems concerned with load transmission via surfaces which are mainly loaded by shear can contribute to achieve a well defined anchorage of implants.

[Blood pressure reactivity to emotional stress in uncomplicated forms of hypertension (author's transl)]

Blood pressure behavior under basal conditions and emotional stress was examined in 48 patients with elevated casual blood pressure values who had no hypertensive cardiovascular complications and in 48 normotensives of the same age. In order to study possible interactions with age and sex each group was divided in two age and two sex subgroups respectively. Under basal conditions the blood pressure values of the hypertensive group were within the normal range but markedly higher than the values of the normotensive group. During stress the difference between both groups increased because the hypertensive group exhibited a stronger reactivity of blood pressure. There was an interaction between sex and hypertension in that in contrast to the hypertensive group normotensive women had lower blood pressure values at rest and under emotional stress than men. There was an influence of age consisting in a stronger blood pressure reactivity of the older subjects; this effect could be found in the hypertensive as well as in the normotensive group. Patients with uncomplicated forms of hypertension exhibit a blood pressure hyperreactivity on emotional stress independently of age and sex. According to previous investigations normotensive subjects with a family history of hypertension show stronger blood pressure reactivity, too. Therefore this phenomenon must be regarded as important in the pathogenesis of essential hypertension.