Follow-up of electromyographic and cephalometric findings in patients with unilateral cleft lip and palate after fifteen months of continuous wearing of a special removable appliance

A 15-month follow-up study was conducted on 13 children with unilateral cleft lip and palate. The patients presented with short upper lip, abnormal lip seal, and maxillary retrusion. All had undergone surgery in childhood. Cephalometric and electromyographic measurements were made prior to the start of treatment, 4 months into treatment, and after 15 months of continuous wear of a special removable appliance. The cephalometric measurements on paired comparison showed major improvement in both the sagittal maxillary and dentoalveolar positions. The electromyographic activity of the superior orbicularis oris muscle demonstrated no significant changes over the treatment period. Improvement in the sagittal maxillary and dentoalveolar positions seems to suggest that the elimination of the restrictive effect of the superior orbicularis oris muscle is a good therapeutic approach to promote normal growth potential in children with cleft lip and palate.

Influence of variation in jaw posture on sternocleidomastoid and trapezius electromyographic activity

This study was conducted in order to determine the influence of variation in the occlusal contacts on electromyographic (EMG) cervical activity in 20 patients with myogenic cranio-cervical-mandibular dysfunction. EMG recordings during maximal voluntary clenching were performed by placing surface electrodes on the left sternocleidomastoid and upper trapezius muscles in the following conditions: intercuspal position; edge to edge left laterotrusive contacts (ipsilateral); edge to edge right laterotrusive contacts (contralateral); edge to edge protrusive contacts; and retrusive occlusal contacts. A significant higher EMG activity was recorded in both muscles during maximal voluntary clenching in retrusive occlusal contact position, whereas no significant differences in EMG activity were observed between intercuspal position, ipsilateral, contralateral and protrusive contact positions. The EMG pattern observed suggests that a more frequent intensity and duration of tooth clenching in retrusive occlusal contact position could result in more clinical symptomatology in these cervical muscles in patients with myogenic cranio-cervical-mandibular dysfunction.

Autonomic neuropathy in chronic alcoholism: evaluation of cardiovascular, pupillary and sympathetic skin responses

Autonomic nerve function was evaluated in 30 alcoholics and 30 healthy subjects by means of cardiovascular function tests, pupil cycle time (PCT), and sympathetic skin responses (SSR). Nutritional status was assessed by anthropometric parameters. Autonomic cardiovascular dysfunction was classified as early involvement in 5 patients, definite in 8, severe in 6 and atypical in 3. PCT was abnormal in 17 alcoholics. The duration of PCT became progressively longer as the severity of cardiovascular involvement increased. SSR was absent in 4 alcoholics in the palm and in 16 in the sole. These findings indicate that sympathetic and parasympathetic mediated functions are abnormal in chronic alcoholics with a similar frequency, involving different sites of the autonomic nervous system under variable patterns. Significant correlations between nutritional status and autonomic neuropathy were found.

Influence of stabilization occlusal splint on craniocervical relationships. Part II: Electromyographic analysis

The aim of this study was to determine the effect of stabilization occlusal splints on electromyographic (EMG) activity of sternocleidomastoid and trapezius muscles in subjects with spasm in the mentioned muscles. A full-arch maxillary stabilization occlusal splint was made for each of the 15 subjects. In the sternocleidomastoid muscle, tonic and saliva swallowing EMG activity decreased significantly with the splint, whereas maximal clenching activity did not change. In the trapezius muscle, no significant changes were observed with the occlusal splint. The different pattern in both muscles during tonic and swallowing EMG activity with the splint is attributed to differences in the synaptic inputs to the respective motoneuron pools, suggesting that a differential modulation of the motor neuron pools may exist of both muscles, of peripheral and/or central origin.

Response to repeated phlebotomies in patients with non-insulin-dependent diabetes mellitus

Regardless of type, uncontrolled diabetes represents a serious disruption of fuel homeostasis with consequences throughout the body. This may hamper the applicability of predeposited autologous blood transfusion in diabetic patients because metabolic changes are expected as a consequence of repeated bleeding. We undertook this study to determine whether the presence of non-insulin-dependent diabetes mellitus (NIDDM) influences the erythropoietin (EPO) response to repeated phlebotomies with respect to normal subjects. We included 22 consecutive patients scheduled for major surgery during a 2-year period in which clinical and metabolic complications were excluded and renal and liver function was considered unaffected. Selected biochemical and hematologic variables were serially measured during donation of several units of blood in a 12- to 29-day period. Bleeding produced a significant decrease in serum glucose, cholesterol, triglyceride, and apoprotein B concentration in diabetic patients. Except for glucose, this effect was not observed in controls. Both groups were comparable with respect to initial hemoglobin concentrations and all hematologic variables measured. The decrease in hemoglobin concentration did not produce clinical symptoms in these patients, and recovery was regarded as normal in both groups. Serum EPO levels in diabetic patients were negatively influenced by the initial hemoglobin A1c (HbA1c) proportion. Moreover, three nonrespondent diabetic patients with poor glycemic control responded normally 6 to 13 months later, in a second operation, when glycemic control had improved significantly. In conclusion, NIDDM may limit the donation of requested units for major surgery only if poor glycemic control is present. When possible, phlebotomies should be delayed and metabolic control reinforced.

Influence of stabilization occlusal splint on craniocervical relationships. Part I: Cephalometric analysis

This study was conducted in order to determine the effect of an occlusal splint on craniocervical relationships, in subjects with muscle spasms in the sternocleidomastoid and trapezius muscles. A full-arch maxillary stabilization occlusal splint was made for each of the 15 subjects. Two lateral craniocervical radiographs were taken for each subject, with and without an occlusal splint. Cephalometric analysis showed that the splint caused a significant extension of the head on the cervical spine. There was also a significant decrease in the cervical spine lordosis in the first, second and third cervical segment. These cervical changes could be a compensation mechanism caused by the extension of the cranium on the upper cervical spine. The change in the curvature implies that it is necessary to periodically evaluate the changes occurring in the craniocervical relationships after the occlusal splint has been inserted.

[Clinical effectiveness of naloxone in acute ethanol intoxication]

The first articles trying to link the effects of ethyl alcohol with those of opiates appeared in 1970. The first case of reversion from ethylic coma due to naloxone was described in 1978. Since then, many authors have reported different results related to the effectiveness of opiate antagonists in this clinical situation, without any of the studies showing a beneficial effect from its use. The purpose of the present study is to perform a double-blinded clinical trial with placebo to evaluate naloxone's clinical effectiveness in severe ethylic intoxication, using the Glasgow test (GT) to measure the level of consciousness. Treatment was randomly assigned to 38 patients of whom 18 received 2 mg of naloxone and 20 a placebo. Among the results, it was found that the best approximation of the level of alcoholemia responsible for ethylic coma, without the involvement of other toxic psychotropes, was made using the Glasgow test, especially in patients who are occasional drinkers. It was shown that naloxone indeed lacks effectiveness in ethylic coma, raising the level of consciousness only one or two points in the Glasgow test for the 15 to 45 minutes after its administration and primarily in the group of patients with the lowest levels of consciousness.

The immediate effect of the variation of anteroposterior laterotrusive contacts on the elevator EMG activity

A unilateral maxillary splint divided into three occlusal blocks was built for eight healthy young adults. The three blocks allowed the anteroposterior location of the laterotrusive contacts to vary and to distribute the occlusal force over equivalent periodontal surfaces. The ipsilateral masseteric and temporalis electromyogram (EMG) activities were recorded with surface electrodes during maximal voluntary clenching. The elevator EMG activity with the anterior occlusal block in place was significantly lower than with the intermediate or posterior blocks. The reduction for both elevators with the intermediate block in place did not show a significant variation in comparison to the posterior block of the three blocks inserted. The elevator activity with the three occlusal blocks did not differ from that recorded with the posterior block alone. Neurophysiologic and biomechanical explanations are given related to this laterotrusive elevator muscular behavior.

Comparison of sympathetic sudomotor and skin responses in alcoholic neuropathy

We evaluated sympathetic sudomotor and parasympathetic vagal function in 30 chronic alcoholic patients and 28 control subjects by means of silicone imprints, sympathetic skin responses (SSR), and cardiorespiratory reflex tests. Mean values from alcoholic patients were significantly lower than those from control subjects for all tests. The number of secreting sweat glands (SGN) was below normal in the foot of 18 patients, and in the hand of 7 patients; 16 patients had absent SSR on the sole, and 4 on the palm. Only two patients had both test results abnormal on the hand and 10 on the foot. The SGN did not correlate with the amplitude of the SSR in the subjects studied. There was no clear correlation of abnormalities found in cardiorespiratory tests and sympathetic tests. Abnormalities in sensory nerve conduction were associated with absent SSR, but not with decreased SGN. The silicone mold technique is a more specific test to detect abnormalities in sympathetic efferent fibers, as SSR may be influenced by sensory afferent fiber involvement.

[Exhaustion syndromes in a popular marathon]

The clinical characteristics of seven healthy subjects who required hospital care for an exhaustion syndrome due to extenuated physical exercise during participation in a public marathon are presented. All the patients were used to practising sports activities and in all the cases the symptoms of exhaustion appeared in the last few kilometers of the race. The most frequent symptom found in all the patients was lipothymia with falling to the ground followed by gastrointestinal manifestations, muscle cramping and fever. Upon analysis the signs of rhabdomyolysis and others suggestive of dehydration were observed in all the cases. Leukocytosis was observed in four and hypopotassemia in two. Evolution was good in all the cases with rest and hydroelectrolytic reposition. Finally, the preventive measures to avoid heat stroke and exhaustion syndromes in public marathons are reported.

Influence of stabilization occlusal splints on sternocleidomastoid and masseter electromyographic activity

The present work was conducted in order to determine the effect of stabilization occlusal splints on electromyographic (EMG) activity of sternocleidomastoid and masseter muscles, in subjects with tenderness to palpation in these muscles. A full-arch maxillary stabilization occlusal splint was made for each of 14 subjects. Tonic EMG activity, as well as during saliva swallowing and maximal voluntary clenching, was recorded with and without a stabilization occlusal splint inserted. Similar tonic, as well as maximal voluntary clenching EMG activity, with and without the stabilization occlusal splint, was observed. During saliva swallowing, the activity in both muscles was significantly lower with the stabilization occlusal splint. This suggests that daytime use of the stabilization occlusal splint might improve tenderness to palpation in the studied muscles, since the frequency of swallowing function is higher during waking hours.

Influence of mucosal mechanoreceptors on anterior temporalis EMG activity in patients with craniomandibular dysfunction: a preliminary study

An analysis of saliva swallowing and tonic electromyographic (EMG) activity was undertaken in 15 young adult patients with craniomandibular dysfunction with and without a palatal base inserted. Recordings were performed by placing surface electrodes on the right and left anterior temporal muscles. Saliva swallowing and tonic activity were initially recorded with and without the palatal base inserted. After one week of continuous use of the palatal base, EMG activity was recorded again. Nonsignificant differences in EMG activity were observed in the studied conditions. EMG results do not support the therapeutical use of palatal base as a conservative and reversible treatment in patients with craniomandibular dysfunction.

Superior orbicularis oris muscle activity in children with and without cleft lip and palate

An analysis of integrated electromyographic (IEMG) activity of the superior orbicularis oris muscle was undertaken in 15 children with cleft lip and palate who have undergone surgery compared to 10 children without clefts (control group). Bipolar surface electrodes were used for IEMG recordings of resting level activity and during the swallowing of saliva. Similar resting level activity was observed in both groups. During the swallowing of saliva, activity in children with cleft lip and palate was higher than in children without clefts (noncleft children). Moreover, in the cleft lip and palate group, children with abnormal lip seal showed the highest values for IEMG activity during the swallowing of saliva. This fact suggests that with each swallow of saliva, a greater counteracting effect of the superior orbicularis oris muscle could be produced on the growing maxilla. This may result in a significant long-term effect on the growth of the stomatognathic system, since the process of swallowing is a 24-hour function repeated between 600 and 2400 times each day.

Pulmonary tuberculosis in HIV-infected patients with normal chest radiographs

SUBJECTS

Three HIV-infected patients with active pulmonary non-disseminated tuberculosis and normal chest radiograph at clinical presentation and during follow-up are reported. Patients had cough and fever but no other specific symptoms. Löwenstein cultures of specimens from bronchoalveolar lavage in two cases and induced sputum in one yielded Mycobacterium tuberculosis.

CONCLUSIONS

The diagnosis of tuberculosis in HIV-infected patients depends greatly on clinical suspicion by the physician, because of its atypical presentation. Failure to perform appropriate diagnostic tests in HIV-infected patients who present with suspected pulmonary disease will result in underdiagnosis and undertreatment of tuberculosis.

Splenic tuberculosis in patients with AIDS

Splenic tuberculosis is an uncommonly considered diagnosis in clinical practice. We report splenic tuberculosis in three patients with AIDS who were admitted to the hospital because of fever and constitutional syndrome. In all of the patients, abdominal sonography and abdominal computed tomography revealed multiple hypoechoic and hypodense lesions, respectively. In two patients needle aspiration of the spleen with sonographic control was the diagnostic procedure. In the third patient the diagnosis was confirmed after splenectomy. In AIDS patients tuberculosis must be included in the differential diagnosis of hypoechoic and hypodense lesions by means of sonography and computed tomography, respectively, especially in those patients with active tuberculosis.

Blocking of periodontal afferents with anesthesia and its influence on elevator EMG activity

The effect of anesthetic blocking of the periodontal afferents of the canine teeth was studied in order to determine its influence on any changes in the jaw elevation activity. Unilateral integrated EMG recordings were made of the masseter and anterior temporal muscles during maximal voluntary clenching in centric occlusion and laterotrusive position with canine contact. After anesthetic blocking of the periodontal afferents of one or both ipsilateral canines, a significant increase was observed of the EMG activity of both jaw elevator muscles studied, in centric occlusion as well as with canine contact. The elevator activity increase was of a greater magnitude when antagonistic canines were anesthetized. These findings thus support the hypothesis that high threshold periodontal receptors exert an inhibitory effect on jaw elevator muscular activity.

Radiographic findings in pulmonary tuberculosis: the influence of human immunodeficiency virus infection

The chest radiographs and medical records of 166 patients diagnosed as having clinically active pulmonary tuberculosis were reviewed. Forty-nine patients (group I) were seropositives to human immunodeficiency virus (HIV), and 117 patients (group II) did not have known risk factors for HIV infection. Roentgenographic abnormalities were analysed in the two groups, according to nine different radiographic patterns previously defined. The seropositive group had a significantly higher proportion of hilar and/or mediastinal adenopathy (P less than 0.001), infiltrates confined to the lower lung fields (P less than 0.05), and miliary tuberculosis (P less than 0.005). Otherwise, single cavitation and destructive pattern were more frequent in the group II. These data suggest that patients with pulmonary tuberculosis and HIV infection are much more likely to have atypical radiographic findings.

Influence of occlusal splints on bilateral anterior temporal EMG activity during swallowing of saliva in patients with craniomandibular dysfunction

A full-arch maxillary stabilization occlusal splint was made for each of 10 patients with craniomandibular dysfunction. These splints were divided into three sections (one anterior and two posterior). This procedure allowed variation in the anteroposterior centric localization of occlusal contacts, thus permitting the recording of the EMG effects produced by the different occlusal splint sections. The integrated EMG activity was recorded from the right and left anterior temporal muscles during swallowing of saliva in habitual occlusion and with the different occlusal splint sections inserted. EMG activity during swallowing of saliva was significantly lower with the different occlusal splints than in habitual occlusion. This supports the rationale for diurnal wear of the occlusal splint. No differences in EMG activity were found during swallowing of saliva when different sections of the occlusal splints were used. This fact points out the possibility for therapeutic use of different occlusal splints for improving swallowing function.

Influence of mucosal mechanoreceptors on elevator muscle activity in healthy subjects

An analysis of saliva swallowing and tonic electromyographic activity was undertaken in 15 healthy subjects with complete natural dentitions with and without a palatal base inserted. Recordings were performed by placing surface electrodes on the left anterior temporal and masseter muscles. In eight subjects tonic electromyographic patterns of activity differed for the two muscles, depending upon the presence of the palatal base, whereas during swallowing of saliva only four subjects showed different patterns. In tonic activity of elevator muscles, there is probably a differential peripheral and/or central modulation of motoneuron pools of both elevator muscles. The lower different pattern in electromyographic activity of the two muscles during saliva swallowing in the intercuspal position suggests that periodontal mechanoreceptor stimulation might have such a powerful influence on electromyographic activity of both muscles that any difference originating in other inputs could have been obscured.