The ageing joint-standard age- and sex-related values of bone erosions and osteophytes in the hand joints of healthy individuals

OBJECTIVE

To analyze the age-related changes of the physiological hand joint architecture.

METHOD

To address this concept, healthy individuals (each 10 women and 10 men in six different age decades spanning from 21 to 80 years) were recruited through a field campaign, investigated for the absence of rheumatic diseases and other comorbidities and received high-resolution quantitative computed tomography (HR-pQCT) examination of the hand joints. Number and extent of erosions and osteophytes were quantified across the ages and different sexes.

RESULTS

Bone erosions [median (Q1-Q3), 1 (0-2)] and osteophytes [2 (1-4)] were found in healthy women and men with no significant sex differences. Structural changes however accumulated with age: the overall incidence rate ratio (IRR) for the number of erosions and osteophytes per age were 1.04 (95% CI: erosions 1.03-1.06; osteophytes: 1.03-1.05). This means a 4% increase in the number of erosions and osteophytes per year. Using third decade as reference, healthy individuals in the age decades from 50 years had higher IRR for erosion numbers (sixth, seventh, eigth decade: 4.87 (2.20-11.75), 6.81 (3.08-16.46) and 6.92 (3.11-16.79)) compared to younger subjects (fourth, fifth decade: 1.80 (0.69-4.87), 1.53 (0.59-4.10)). The IRRs of osteophytes also indicate a gradual increase after the fifth decade, with IRRs of 2.32 (1.32-4.17), 4.17 (2.38-7.49) and 6.86 (3.97-12.20) for the sixth, seventh and eigth decades, respectively.

CONCLUSIONS

Structural changes in the hand joints of healthy individuals are age dependent. While being rare under 50 years of age, erosions and osteophytes accumulate above the age of 50, suggesting that the threshold between "normal" and "pathological" is shifted with the increase of age.

Gegenüberstellung der Szintigraphie und Angiographie in der Diagnostik von intrakraniellen raumfordernden Prozessen

Die Verfasser untersuchten hirnszintigraphisch 573 Patienten, bei denen 179mal eine intrakranielle Raumforderung nachgewiesen wurde — 166 Tumore, 7 Abszesse und 6 subdurale Hämatome. Die diagnostische Treffsicherheit betrug 90%. Im Vergleich zur Angiographie trug sie in 55% der intrakraniellen raumfordernden Prozesse ausschlaggebend bei, bei denen die Angiographie entweder negativ ausfiel, bei denen im Angiogramm nur indirekte Raumverdrängungszeichen vorlagen oder wo sie aus verschiedenen Gründen nicht durchgeführt werden konnte. Die zerebrale Szintigraphie bewährte sich nicht nur als atraumatischer „screening test“ in der Detektion von intrakraniellen Herdläsionen, sie steuerte auch beträchtlich im Rahmen der komplexen Untersuchung zur Festlegung der Enddiagnose und des Therapieplanes bei.

HMR 1883, a cardioselective K(ATP) channel blocker, inhibits ischaemia- and reperfusion-induced ventricular fibrillation in rats

Ventricular fibrillation (VF) is a major cause of sudden cardiac death in which myocardial ischemia plays a leading role. During ischaemia activation of ATP-sensitive potassium channels (K(ATP)) occurs, leading to potassium efflux from cardiomyocytes and shortening of the action potential favoring the genesis of ventricular fibrillation. In confirmation of this concept the sulfonylurea glibenclamide, which stimulates insulin release by inhibition of pancreatic K(ATP) channels, has been shown to inhibit VF in different models of ischaemia by inhibition of myocardial K(ATP) channels. HMR 1883 (1-[15-12-(5-chloro-o-anisamido)ethyl]-methoxyphenyl]sulfonyl]-3-m ethylthiourea) was designed as a cardioselective K(ATP) channel blocker. The aim of this study was to show that with this compound it is possible to separate the antifibrillatory from the insulin-releasing effect for the treatment of patients at risk of ischaemia-induced arrhythmias and sudden death. In the present study HMR 1883 reduced VF in Sprague-Dawley rats during prolonged ischaemia and also diminished mortality and the duration of VF in a separate reperfusion experiment at 3 mg/kg and 10 mg/kg with no effect on blood glucose or insulin. Glibenclamide, which was antifibrillatory at 0.3 mg/kg and 1 mg/kg, increased plasma insulin and lowered blood glucose already at a dose as low as 0.01 mg/kg. In conclusion, based on its antifibrillatory action and the absence of significant pancreatic effects at therapeutic doses, HMR 1883 is of potential clinical utility for the prevention of severe arrhythmias in patients with ischaemic heart disease.

Low molecular thymic peptides improve the deficient immunocytotoxicity of mononuclear cells from tumor patients in vitro

We studied, in vitro, the stimulating effects of a commercial preparation of low molecular thymic peptides (TP) on the immunocytotoxicity of peripheral blood lymphocytes and monocytes from patients with breast tumors, melanoma and colorectal tumors. On average, tumor patients showed a lower natural killer (NK), lymphokine (IL-2) activated killer (LAK) cell and basic tumoristatic activity of monocytes, compared with healthy donors. There was no correlation between the NK-cell number and the NK-cell activity of the tumor patients. The TP showed no effects on the NK-cell activity in any group, yet elevated the deficient LAK-cell activity of tumor patients and that of healthy donors. On monocytes, TP enhanced the deranged tumoristatic activity only in tumor patients, while being slightly inhibitory on control monocytes. Dividing the donors on the basis of the TP effects on cytotoxicity of the mononuclear cells into TP-nonresponders and TP-responders, a higher number of TP-responders was found among tumor patients, compared with healthy donors. Moreover, a higher number of TP-nonresponders were observed with lymphocytes from colorectal tumor patients at advanced tumor stage. Therefore, on the basis of the applied immunocytotoxic assays, these results may provide a basis for selecting tumor patients, who may respond to TP in immunotherapy protocols.

Determination of 113Cd shielding tensor components in cadmium-phosphine complexes from 31P-decoupled 113Cd cross-polarisation/magic angle spinning spectra

Owing to the simultaneous presence of various anisotropic interactions within the isolated M-31P and M(31P)2 fragments in solid transition metal phosphine complexes MX2.PR3 and MX2.2PR3 with, for instance, M = Cd, Hg or Pt, it is not normally possible to unequivocally determine the shielding tensor components of the metal nucleus M from simple 113Cd, 199Hg or 195Pt cross-polarisation/magic angle spinning (CP/MAS) spectra. In this paper it is shown that additional 31P on-resonance high-power decoupling during the acquisition time does allow the determination of the shielding tensor components of M from CP/MAS spectra. Two cadmium(II) complexes, Cd(OAc)2.Pchex3, (chex = cyclohexyl) and Cd(ClO4)2.2Pchex3 were chosen as examples; the 113Cd CP/MAS experiments were carried out at a low external magnetic field strength B0 = 2.35 T.

[Principles of pain therapy with local anesthesia]

The treatment of chronic pain consists of four basic concepts: Drugs (analgetic drugs, TAD, etc.), treatment by physicians (chiropraxis, massage, TENS, etc.), injection with local anesthetics and autosuggestion. Necessary for diagnosis and treatment of chronical pain is the knowledge of pathophysiology and anatomy of nerves, ligaments, muscles and the sympathetic nervous system. Diagnosis of chronical pain rarely includes roentgenograms or other technical procedures, mainly to exclude tumors, fractures or specific infections. The knowledge of pathophysiology means the knowledge of sympathetic and motoric efferences on one side and the functional examination of the anatomic structures on the other side.

Ramipril prevents the detrimental sequels of chronic NO synthase inhibition in rats: hypertension, cardiac hypertrophy and renal insufficiency

Inhibition of the angiotensin converting enzyme (ACE) with ramipril was studied in male Wistar rats during long-term inhibition of nitric oxide (NO) synthase by NG-nitro-L-arginine methyl ester (L-NAME). Chronic treatment with L-NAME in a dose of 25 mg/kg per day over 6 weeks caused myocardial hypertrophy and a significant increase in systolic blood pressure (245 +/- 16 mmHg) as compared to controls (155 +/- 4 mmHg). Animals receiving simultaneously L-NAME and ramipril were protected against blood pressure increase and partially against myocardial hypertrophy. L-NAME caused a significant reduction in glomerular filtration rate (GFR: 2.56 +/- 0.73 ml.kg-1.min-1) and renal plasma flow (RPF: 6.93 +/- 1.70 ml.kg-1.min-1) as compared to control (GFR: 7.29 +/- 0.69, RPF: 21.36 +/- 2.33 ml.kg-1.min-1). Addition of ramipril prevented L-NAME-induced reduction in GFR and renal plasma flow. L-NAME produced an elevation in urinary protein excretion and serum creatinine and a decrease in potassium excretion which was antagonised by ramipril. L-NAME-induced increase in plasma renin activity (PRA) was further elevated with ramipril treatment. Isolated hearts from rats treated with L-NAME showed increased post-ischaemic reperfusion injuries. Compared to controls duration of ventricular fibrillation was increased and coronary flow reduced. During ischemia the cytosolic enzymes lactate dehydrogenase and creatine kinase, as well as lactate in the venous effluent were increased. Myocardial tissue values of glycogen, ATP, and creatine phosphate were decreased, whereas lactate was increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Diminished diuretic and natriuretic response to furosemide in potassium-depleted rats

Renal clearance and tubule microperfusion experiments were carried out to investigate the effects of chronic potassium depletion upon the renal response to furosemide. Rats kept on a potassium-deficient diet for 3 weeks developed hypokalemia, metabolic alkalosis, and decreased aldosterone levels. These rats responded to an oral administration of furosemide (32 mg/kg) with a blunted excretion rate of urine and sodium. Whereas furosemide increased fractional urine sodium excretion to 5.2% in control rats, the corresponding rate in potassium-depleted rats was 2.8%. The urinary excretion of furosemide was also significantly reduced during potassium depletion from 3.06 mg/kg in control rats to 0.97 mg/kg in potassium-depleted rats. In separate experiments, loops of Henle were pump-perfused with furosemide-containing solutions in control and potassium-depleted rats. No major modification of the inhibitory effects of furosemide on sodium transport was observed when the potassium concentration of the perfusion fluid was kept at the low levels expected in hypokalemic rats. Metabolic alkalosis unaccompanied by potassium deprivation did not decrease the diuretic response to furosemide. These experiments indicate that potassium deprivation reduces the diuretic effects of furosemide by mechanisms including diminished furosemide delivery to its tubule site of action.

Cardiovascular effects of the novel potassium channel opener (3S,4R)-3-hydroxy-2,2-dimethyl-4-(2-oxo- 1-pyrrolidinyl)-6-phenylsulfonylchromane hemihydrate

Cardiovascular effects of the novel potassium channel opener (3S,4R)-3-hydroxy-2,2-dimethyl-4-(2-oxo-1-pyrrolidinyl)-6- phenylsulfonylchromane hemihydrate (Hoe 234, CAS 132014-21-2) were investigated in rats, dogs and monkeys. In all species and independent of the route of administration Hoe 234 lowered systemic blood pressure accompanied with increases in heart rate. In rats after intravenous (i.v.) application Hoe 234 was 3 times more potent than cromakalim and its effects were reduced by pretreatment with the potassium channel blocker glibenclamide. Following intraduodenal application again Hoe 234 was more potent but mean arterial blood pressure (MAP) decreased more slowly and maximal effects were obtained later than after cromakalim. Oral administration of either single or repeated doses, however, revealed a somewhat higher potency for cromakalim. In anesthetized dogs Hoe 234 i.v. reduced MAP more potently than cromakalim whereas changes in heart rate were less pronounced. Cardiac output was increased and total peripheral resistance decreased for either agent. These results show that Hoe 234 is a novel potassium channel opener lowering blood pressure in animals due to peripheral vasodilation. It compares favourable with known potassium channel openers except for oral administration.

Pharmakodynamik und Pharmakokinetik von rekombinantem Hirudin (HBW 023) nach einmaliger intravenöser oder subkutaner Applikation an Rhesus-Affen

Die Pharmakodynamik und Pharmakokinetik von rekombinantem DNA-Hirudin HBW 023 wurde an Rhesus-Affen in Dosen von 0,1; 0,5; 1,0 und 10,0 mg/kg nach einmaliger intravenöser oder subkutaner Applikation untersucht. HBW 023 zeigte eine dosisabhängige Verlängerung der gemessenen Gerinnungsparameter. Am empfindlichsten reagierten die TZ und die PTT. Die Abhängigkeit der PTT von der aktuellen HBW-023-Plasmakonzentration war statistisch signifikant (p <0,01). Die Spearmanschen Rang-Korrela-tionskoeffizienten betrugen für intravenöse und subkutane Applikation 0,789 bzw. 0,836.

Die Plasmakonzentration von HBW 023 wurde nach subkutaner Applikation durch die Bateman-Funktion (Ein-Kompartment-Modell) und nach intravenöser Gabe durch die Gleichung für ein offenes Zwei-Kompartment-Modell beschrieben. Die Eliminations-Halbwertszeiten wiesen in bezug auf den Applikationsweg mäßige Unterschiede auf. Innerhalb von 24 Stunden wurden ca. 48% (i.v.) bzw. 70% (s. c.) der verabreichten Dosis von HBW 023 im Harn ausgeschieden.

Coronal radiographs and videofluoroscopy improve the diagnostic quality of temporomandibular joint arthrography

Detection of mediolateral displacement of the temporomandibular joint (TMJ) meniscus and evaluation of the reducibility of this displacement are necessary because surgery is indicated when the displacement is irreducible. During TMJ arthrography, the routine sagittal study does not allow detection of this type of meniscal displacement. In a prospective study of 158 TMJ arthrograms in 83 patients, coronal radiographs were obtained and videofluoroscopy was performed (in addition to routine sagittal films and fluoroscopy) to detect mediolateral shift of the meniscus and to evaluate the reducibility of this displacement. Both upper and lower joint spaces were opacified. Coronal and lateral radiographs were obtained with the mouth open and closed. On coronal images, in 79 cases (50%) the meniscus was shifted medially, in 22 cases (14%) laterally, and in 57 cases (36%) it was in the normal position. In 90 (89%) of the 101 abnormal cases, anterior displacement was associated with a mediolateral shift. In 59 cases (58%), the mediolateral shift was irreducible. Coronal and lateral views and fluoroscopy were reviewed separately by two observers, whose conclusions were identical for all cases. In 32 (54%) of the 59 joints with irreducible mediolateral displacement, surgery was performed. For all of these, comparison of radiologic data with surgical findings indicated that coronal views and videofluoroscopy were diagnostic, whereas mediolateral displacements were not detectable on routine sagittal studies.

Influence of seasonal biorhythms on urinary excretion of enzymes and other parameters

Urinary excretion of enzymes, electrolytes, creatinine, protein and the consumption of food and water in female and male Wistar rats was examined over two seasons of summer and wintertime, respectively. The evaluation of data revealed that gamma-glutamyltransferase, inorganic phosphate, and the lysosomal enzymes, N-acetyl-beta-D-glucosaminidase and acid phosphatase, were significantly different between the collection periods in both seasons. Other parameters showed significant differences only in male rats, whereas urinary electrolytes, with the exception of chloride, showed no significant differences.

Loose bodies of the temporomandibular joint: arthrographic and CT findings in five patients

We report a series of five patients with symptoms of internal derangements of the temporomandibular joint (TMJ), in whom intraarticular loose bodies were found. Three patients with a single loose body had osteochondrosis dissecans of the temporal part of the joint; one trauma patient had two loose bodies (including a bony and a meniscal fragment). The fifth patient presented with a loose meniscal fragment and a complete meniscal rupture, complicating a long-lasting TMJ dysfunction due to non-reducible anterior meniscus displacement. The diagnosis was made by arthrotomography (3 cases), CT (one case) and by CT and arthrotomography (one case). Surgical confirmation was obtained in all patients. Arthrography and CT are accurate in diagnosing TMJ loose bodies; characteristic findings disclosed in both examinations are described.

[Temporomandibular arthrography. Contribution of the frontal view in the diagnosis of meniscus displacement. Preliminary study]

Coronal arthrographic views of the temporomandibular joint (TMJ) are easily obtained. The meniscus is nicely depicted in the coronal plane after adequate opacification of both joint compartments. Medial versus lateral displacements of the meniscus are well depicted. Pre-operatively it is as important to disclose a medio-lateral displacement of the meniscus than to quantify the degree of an anterior meniscus displacement.

What consequences should be considered if an asymptomatic aneurysm of the middle cerebral artery is detected angiographically after performing an extra-intracranial by-pass for treatment of an internal carotid artery occlusion?

The possible therapeutical consequences of the situation described in the title are discussed and illustrated by the description of such a case.

Enzymuria in streptozotocin-diabetic rats

Twenty four hour urine samples of male control and streptozotocin-diabetic Wistar rats were analysed for a series of commonly known kidney-specific enzymes, for electrolytes, creatinine, glucose, total protein and urine volume. The examination was done during two periods of 5 days between the 25th and 30th and the 32nd and 36th day after streptozotocin application. In the first period the animals had free access to food and water, whereas in the second period on days 32, 34 and 36 food was withdrawn. In the first observation period the diabetic rats showed increased excretion rates of 15 measured urinary parameters, while alanine aminopeptidase (EC 3.4.1.2) and gamma-glutamyltransferase (EC 2.3.2.2) activities were lowered and inorganic phosphate was unchanged. The removal of food resulted in decreased excretion values for alanine aminopeptidase, gamma-glutamyltransferase and total protein as compared with fasted nondiabetic animals. The activities of N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30), acid phosphatase (EC 3.1.3.2), lactate dehydrogenase (EC 1.1.1.27), pyruvate kinase (EC 2.7.1.40), C1-fructose 1.6-diphosphatase (EC 3.1.3.11) and the excretion values for sodium, calcium, magnesium, chloride and glucose were higher than in fasted nondiabetic rats. beta-Glucosidase (EC 3.2.1.21), potassium, inorganic phosphate, creatinine, and urine volume showed no differences between fasted diabetic and fasted control animals. The enzymes in the renal cortex at the end of the experiment showed only decreased activity of alanine aminopeptidase in diabetic rats. Lactate dehydrogenase, pyruvate kinase, beta-glucosidase, C1-fructose 1.6-diphosphatase and glucose 6-phosphatase (EC 3.1.3.9) were increased and gamma-glutamyltransferase, N-acetyl-beta-D-glucosaminidase, acid phosphatase and glucose 6-phosphate dehydrogenase (EC 1.1.1.49) showed no change.(ABSTRACT TRUNCATED AT 250 WORDS)

Enzymuria of the rat: biorhythms and sex differences

Alanine aminopeptidase, gamma-glutamyltransferase and N-acetyl-beta-D-glucosaminidase were measured daily over 65 days in 24-hour urine of male and female Wistar rats. The mathematical evaluation was based on the Fourier-analysis. The excretion of alanine aminopeptidase and gamma-glutamyltransferase was higher in male than in female rats. This sex-dependent difference was not observed for N-acetyl-beta-D-glucosaminidase. The excretion of the 3 enzymes followed a biorhythm with a dominant period of 7 days for gamma-glutamyltransferase and N-acetyl-beta-D-glucosaminidase and one of 9 days for alanine aminopeptidase. Biorhythms and sex differences of enzymuria should be considered in experimental designs.

The understanding heart: aging parents and their favorite children

This paper compares the characteristics of adult children who provide comfort and sympathy and serve as confidants to parents with those whom parents perceive as disappointing. Interview information from 117 couples having children who had left home was analyzed using aggregate and intrafamilial strategies. The latter analyses compared the characteristics of the selected child with those of her or his sibs instead of comparing the aggregate of selected children with the aggregate of their siblings. Differences in the findings from the 2 techniques are discussed. The findings confirmed the importance of daughters who live nearby as understanding children. More important than proximity among the factors influencing parental judgments on disappointing and understanding children were intergenerational shared interests and values.

[Roentgen diagnosis of intervertebral disk calcification in children]

From an analysis of their own patients and of the radiological appearances of juvenile disc calcification as described in the literature, the authors have subdivided the evolution of this condition into three phases. The third phase (residual effects) is given the most detailed consideration.

Enzymuria of the rat: the preparation of urine for enzyme analysis

The effects of sample preparations by dialysis and gel filtration on the catalytic concentrations of alanine aminopeptidase, N-acetyl-beta-D-glucosaminidase, and beta-glucuronidase are described. Individual urines were collected during 24 hours on 3 consecutive days from 10 male rats. Gel filtration (Sephadex G25) was more effective than dialysis against water in the removal of inhibitors of N-acetyl-beta-D-glucosaminidase and beta-glucuronidase. For alanine aminopeptidase, slightly higher results were obtained by dialysis. Inhibitor contents varied from day to day. Activity decreases of beta-glucuronidase and N-acetyl-beta-D-glucosaminidase were found in some of the urine samples and interpreted as removal of activators. Gel filtration is recommended for the preparation of rat urine for the measurement of these three enzymes. The slightly inferior effect of gel filtration on alanine aminopeptidase should be disregarded for the sake of practicality.

[Von Recklinghausen's neurofibromatosis with intracranial stenosis of the internal carotid artery and orbito-sphenoidal bone dysplasia (author's transl)]

A patient with fibromatosis of the skull and a so-called "parophthalmicus syndrome" is described in whom there was hypoplasia and stenosis of the homolateral internal carotid artery and aplasia of the ophthalmic artery. The vascular changes in this phakomatosis are discussed. We suggest that the vascular changes in the carotid be included in the extended parophthalmicus syndrome.