Asymptomatic Adult Volunteers Research Articles

Sonography of the superomedial part of the spring ligament complex of the foot: a study of cadavers and asymptomatic volunteers

To evaluate the ability of high-resolution sonography for assessing the thickness and echogenicity of the superomedial part of the normal spring ligament in the foot in cadavers and asymptomatic volunteers. The superomedial part of the normal spring ligament of four cadaveric feet was imaged with a high-resolution linear array transducer. Upon localization, the ligament was injected with 0.1% methylene blue with sonographic guidance. A posteromedial approach was used to dissect the feet immediately following injection to confirm accurate identification of the ligament. The bilateral ligaments in 40 asymptomatic adult volunteers were subsequently imaged. Surgical dissection confirmed the accurate injection of methylene blue into all four cadaveric ligaments. The superomedial part of the normal spring ligament was identified bilaterally in all of the 40 asymptomatic volunteers, with a mean thickness of 3 mm in longitudinal short axes. The ligament was echogenic relative to surrounding fat, and it was thinner in women. Differences in ligament measurements with respect to age, sex, side (left vs. right) and foot dominance were not significant. The volunteers' height, weight and body mass index had a weakly positive correlation with ligament thickness. High-resolution ultrasound can be used to identify and measure the thickness of the superomedial part of the normal spring ligament. The provided baseline measurements for the normal ligament could prove valuable when assessing the abnormal ligament.

Quantum Events of Biophoton Emission Associated with Complementary and Alternative Medicine Therapies: A Descriptive Pilot Study

Biophoton emission (BPE) is a quantum event characterized by a relatively stable but ultralow- rate emission of visible photons from living organisms. It has been associated with high energy processes such as: cell metabolism, growth, phagocytosis, neural activity, and oxidative stress. BPE has also been suggested to reflect the organism's global state of health as well as the response to stimulation including therapeutic interventions. If BPE changes occur as a result of various complementary and alternative medical interventions, this could prove useful to monitor both the patient's response to a specific treatment and global changes in their health status. This descriptive study attempts to identify BPE changes associated with three different chiropractic techniques that use different energetic approaches: mechanical, gravitational, and bioenergetic. The BPE was measured at the neck and/or the lower back of 3 asymptomatic adult male volunteers. The measurements were made before and after different chiropractic interventions. The treatment techniques included a high velocity joint manipulation with the aid of a drop table, Sacro-Occipital Technique, and Bio-Energetic Synchronization Technique. Enough time was allotted for measurements in order to differentiate between natural fluctuation of the BPE and the changes induced by the interventions. All techniques induced small (up to 20%) but statistically significant changes (p < 0.05 in one case, p < 0.001 in the other two) in the BPE. Each technique demonstrated a different pattern of BPE change that may be specific to the technique. The intensity of BPE is a noninvasive indicator of the health of the human body and is significantly altered in different ways by chiropractic interventions. Future research is necessary to explore more features of BPE and its utility as an indicator of health, as well as the theoretical and clinical significance of these findings.

Avaliação do tempo de trânsito colônico com marcadores radiopacos: estudo com voluntários assintomáticos

OBJETIVO: Com a introdução de marcadores radiopacos para avaliação do tempo de trânsito intestinal, tornou-se possível mensurar não apenas o tempo de trânsito total, como também o segmentar. Visando a simplificação da técnica, especialmente no que diz respeito à diminuição da exposição à irradiação, foi descrito novo método com número menor de radiografias. Os autores apresentam estudo do tempo de transito colônico total e segmentar em indivíduos normais. MÉTODO: Quinze voluntários adultos e assintomáticos, oito do sexo feminino e sete do masculino, foram submetidos a exame radiológico com marcadores radiopacos para medida do tempo de trânsito colônico total e segmentar (cólon direito, esquerdo e retossigmóide). RESULTADOS: A média do tempo de trânsito colônico total foi de 36,61 ± 3,48 horas. Dos tempos de trânsito segmentares obtivemos as médias de 11,51 ± 2,28 horas para o cólon direito; de 12,14 ± 2,19 horas para o cólon esquerdo; e de 12,96 ± 2,23 horas para o retossigmóide. CONCLUSÕES: A técnica descrita é método simples e útil para a avaliação do tempo de trânsito colônico total e segmentar e quando aplicada a indivíduos assintomáticos reproduziu resultados comparáveis aos da literatura e aos obtidos a partir de outras técnicas.

Analysis of the Sagittal Balance of the Spine and Pelvis Using Shape and Orientation Parameters

The purpose of this study is to introduce a method to analyze and characterize the global sagittal balance of the human trunk using indexes derived from the shape and orientation of the pelvis and cervical, thoracic, and lumbar spine. Standing lateral x-rays of a cohort of 160 asymptomatic young adult volunteers were obtained. On each radiograph, a simplified model of the spine and pelvis was created using a dedicated computer software, and the following shape and orientation variables were calculated at each anatomic level: pelvic incidence, pelvic tilt, sacral slope, cervical curvature and tilt, thoracic curvature and tilt, and lumbar curvature and tilt. Significant linear correlations were found between each single adjacent shape parameter as well as between each single adjacent orientation parameter at all anatomic levels. Significant correlations were also found between some shape and orientation parameters at the same anatomic level as well as between adjacent anatomic areas. In general, the linear correlations were stronger between shape and orientation variables at the pelvic, lumbar, and cervical areas and weaker at the thoracic level and between the thoracic and lumbar areas. These results confirm that the pelvis and spine in the sagittal plane can be considered as a linear chain linking the head to the pelvis where the shape and orientation of each anatomic segment are closely related and influence the adjacent segment to maintain a stable posture with a minimum of energy expenditure. Changes in shape or orientation at one level will have a direct influence on the adjacent segment. Knowledge of these normal relationships is of prime importance for the comprehension of sagittal balance in normal and pathologic conditions of the spine and pelvis.

Major vascular anomalies in Turner syndrome: prevalence and magnetic resonance angiographic features.

Turner syndrome (TS) is associated with aortic coarctation and dissection; hence, echocardiographic evaluation of all patients is currently recommended. X-ray angiography in clinically symptomatic patients has suggested a range of other vascular anomalies, but the true prevalence of such lesions in TS is unknown. To better understand the prevalence and pathogenesis of cardiovascular defects in TS, we prospectively evaluated a group of asymptomatic adult volunteers with TS using magnetic resonance (MR) angiography. A total of 85 adults with TS and 27 normal female adult volunteers underwent gadolinium-enhanced 3D MR angiography. A high prevalence of aortic anomalies was seen in women with TS, including elongation of the transverse arch (49%), aortic coarctation (12%), and aberrant right subclavian artery (8%). Venous anomalies were also prominent, including persistent left superior vena cava (13%) and partial anomalous pulmonary venous return (13%). None of these anomalies were found in healthy female controls. The constellation of elongation of the transverse arch, aortic coarctation, and persistent left superior vena cava was significantly associated with women with TS. Neck webbing and increased thoracic anterior-to-posterior dimension diameters were strong predictors for arterial and venous anomalies. Thoracic vascular anomalies are common in TS, occurring in approximately 50% of a group not preselected for cardiovascular disease. The highly significant association between neck webbing, increased chest diameter, and these vascular anomalies suggests that in utero, centrally localized lymphatic obstruction may contribute to these cardiovascular deformities in TS. Improved recognition of these often-undetected vascular lesions may be important for identification of patients in need of closer cardiovascular monitoring.

Iliotibial band thickness: sonographic measurements in asymptomatic volunteers.

The aims of this study were to measure the thickness of the iliotibial band (ITB) in asymptomatic adult volunteers and to determine whether there was any correlation between these measurements and the subjects' age, weight, or height. Sonography was used to measure the ITB thickness in 31 asymptomatic volunteers (13 men and 18 women) ranging from 25 to 68 years old. Two radiologists obtained the sonographic measurements of each volunteer at the levels of the femoral condyle and the tibial condyle of both knees. Findings of fluid or bursae adjacent to the ITB were recorded. The mean ITB thickness was 1.95 mm +/- 0.3 mm (+/- standard deviation) at the level of the femoral condyle and 3.4 mm +/- 0.5 mm at the level of the tibial condyle. There was a statistically significant negative correlation between ITB thickness and subject age. There was no significant correlation between ITB thickness and subject weight or height. Joint fluid was present in the lateral recess of both knees in 29 volunteers (93.5%) and 1 knee joint in 2 volunteers (6.5%). Bursae were present in 3 volunteers (9.7%). The mean sonographic values of normal ITB thickness established using sonography may be helpful in diagnosing ITB pathology. There is no significant correlation between ITB thickness and subject weight or height, but there is a negative correlation between ITB thickness and subject age. Joint fluid in the lateral recess is present in most asymptomatic individuals, but bursae are rare.

Plasma levels of endothelial protein C receptor respond to anticoagulant treatment

AbstractThe endothelial protein C receptor (EPCR) facilitates protein C activation and plays a protective role in the response toEscherichia coli–mediated sepsis in primates. Previously, a soluble form of EPCR (sEPCR) in human plasma was characterized, and several studies indicated that generation of sEPCR is regulated by inflammatory mediators, including thrombin-mediated up-regulation of surface metalloproteolytic activity in vitro. This study addressed the question of whether plasma sEPCR levels reflect changes in thrombin generation in patients undergoing anticoagulant treatment. The sEPCR levels in patients treated with coumarin-type oral anticoagulants were significantly lower than those in healthy asymptomatic adult volunteers (105.3 ± 70.8 ng/mL [n = 55] versus 165.8 ± 115.8 ng/mL [n = 200]; P < .0001). A similar decline in plasma sEPCR levels was found in patients treated with unfractionated heparin. In healthy volunteers, sEPCR levels declined to about 100 ng/mL within 3 days after initiation of an 8-day period of warfarin administration and increased within 2 days after its cessation. Plasma sEPCR levels returned to pretreatment values within 1 week, and the changes in plasma sEPCR levels mirrored changes in values for international normalized ratios. A similar decline in sEPCR levels with time was observed in 7 patients beginning treatment with warfarin for a thrombotic disorder. Prothrombin fragment 1 + 2 levels also decreased in volunteers and patients given warfarin. These results show that plasma sEPCR levels decline in response to treatment with anticoagulants whose mechanism of action is known to decrease in vivo thrombin production.

Median “pseudoneurapraxia” at the wrist: Reassessment of palmar stimulation of the recurrent median nerve

Park TA, Welshofer JA, Dzwierzynski WW, Erickson SJ, Del Toro DR. Median “pseudoneurapraxia” at the wrist: reassessment of palmar stimulation of the recurrent median nerve. Arch Phys Med Rehabil 2001;82:190-7. Objective: To determine the occurrence and effect of incidental deep ulnar nerve (DUN) costimulation during palmar stimulation of the recurrent median nerve (RMN). Design: Observational. Setting: Electromyography laboratory. Participants: Seventeen asymptomatic adult volunteers (34 hands) and 4 fresh cadaver hands. Main Outcome Measures: Median nerve stimulation at the wrist and careful incremental surface and subcutaneous (needle) palmar stimulation were performed while recording thenar and first dorsal interosseous manus compound muscle action potentials. Thenar palm-to-wrist amplitude difference (P − WΔ) and palm-to-wrist amplitude ratio (P/W) were compared with published values. Correlation of DUN costimulation with falsely elevated P − WΔ and P/W values was assessed. Multiplanar magnetic resonance imaging (MRI) and subsequent dissection of 4 fresh cadaver hands was done to measure the distance between the RMN and DUN at the palmar stimulation site. Results: Two groups emerged: Group I (63%), with DUN stimulation, and II (37%), with no DUN stimulation. When DUN costimulation occurred (Group I), there was a statistically significant increase in P − WΔ (p =.002 percutaneous, p =.02 subcutaneous) and P/W (p =.004 percutaneous, p =.007 subcutaneous) when compared with previously published data. Combining all trials on all hands, 53% and 25% had P − WΔ values and P/W values that exceeded previously published normative data, respectively. The mean distance between the DUN and RMN at the palmar stimulation site was determined by dissection (1.2cm) and MRI (1.5cm). Conclusions: Close proximity of the DUN to the RMN causes frequent and often unavoidable DUN activation during palmar stimulation of the RMN. This inadvertent stimulation may cause a false diagnosis of median neurapraxia at the wrist.

Esophageal mucosal acid sensitivity can coexist with normal pH recording in healthy adult volunteers.

We aimed to determine whether healthy volunteers with normal pH monitoring study results experienced heartburn or discomfort during an esophageal acid perfusion test. We performed an esophageal acid perfusion test, followed by ambulatory esophageal pH monitoring, in 15 healthy and asymptomatic volunteers (aged 19 to 34 years). The results of the acid perfusion test were correlated with those of the pH monitoring. Three subjects (20%) reported chest discomfort during acid perfusion. The pH data in all subjects were within our laboratory reference ranges; the median (range) percent total time at pH < 4 being 1.7 (0.2-4.0)% [laboratory reference, median (range), 3.0 (0.2-4.0)%]. We concluded that direct infusion of acid onto the distal esophagus can produce discomfort akin to that of gastroesophageal reflux disease in asymptomatic adult volunteers, even in the absence of excessive esophageal acid exposure.

Evaluation of position and configuration of the temporomandibular disk in asymptomatic adult volunteers using MR image

Evaluation of position and configuration of the temporomandibular disk in asymptomatic adult volunteers using MR image

Bolus aggregation in the oropharynx does not depend on gravity

Objective: To determine whether bolus aggregation in the oropharynx (before swallowing) depends on gravity. Design: Before-during trial, with subjects serving as their own controls. Setting: Hospital radiology suite. Participants: Five asymptomatic adult volunteers. Interventions: Videofluorography was performed while subjects ate soft and hard foods containing barium, first seated upright and then kneeling face down (quadruped position). Main Outcome Measures: Duration of food processing in the oral cavity, bolus aggregation in the valleculae, and pharyngeal swallow. Results: Transport of chewed solid food from the oral cavity to the oropharynx (stage II transport) typically started several seconds before onset of swallow, regardless of head position or initial food consistency. Bolus aggregation in the valleculae (between the epiglottis and the tongue) began an average of 1.7 ± 2.5sec before the onset of the pharyngeal swallow ( p < .001). Stage II transport was driven by tongue-palate contact. Conclusions: Transport of chewed solid food from the oral cavity to the pharynx is driven actively by tongue-palate contact and does not depend on gravity. A bolus may accumulate in the valleculae for several seconds before the swallow.

Peroneus brevis tendon in normal subjects: MR morphology and its relationship to longitudinal tears.

The most prevalent, yet unproven, theory for the development of longitudinal splits of the peroneus brevis tendon is the compression of the peroneus brevis tendon by the peroneus longus tendon in dorsiflexion. The goal of our study was to provide insight into this pathomechanism by evaluating the shape of the peroneus brevis tendon and its relationship to the adjacent structures in the fibular groove during plantarflexion and dorsiflexion. The MR images of 13 ankles in asymptomatic adult volunteers were performed in full dorsiflexion and plantarflexion. The axial MR images were assessed for the shape of the peroneus brevis tendon and its relationship to the peroneus longus tendon and posterior cortex of the fibula in both plantarflexion and dorsiflexion. In 12 of the 13 volunteers, the peroneus brevis tendon was located anterior or anteromedial to the peroneus longus tendon in the fibular groove. In those volunteers the peroneus brevis tendon was more flattened and compressed against the fibular groove by the overlying peroneus longus tendon in dorsiflexion than plantarflexion. Fat planes were noted in plantarflexion between the peroneal tendons as well as between the peroneus brevis tendon and the fibular groove. These were obliterated in dorsiflexion. The changes in configuration of the tendon of the peroneus brevis tendon in dorsiflexion compared with plantarflexion provide support to our present understanding of the pathomechanism of longitudinal tears of the peroneus brevis tendon.

An electroencephalographic study of imagined movement

Objective: Determine the generator sources for actual and imagined (simulated) movements of fingers and toes. Design: Observational. Setting: Electroencephalography laboratory. Subjects: Ten asymptomatic adult volunteers. Main Outcome Measure: Comparison of cortical electrical fields and their dipole sources in actual and imagined movements. Results: Cortical electrical fields tend to be contralateral with actual movements and midline with imagined movements. Dipole sources of actual movements include a contralateral contribution from the frontal (primary motor) area. Sources of imagined movements are midline or ipsilateral. Conclusions: (1) The motor networks underlying the generation of actual and imagined movements are different. (2) Imagined movements lack a primary motor area source, but involve medial and ipsilateral structures. (3) The effectiveness of imagined movements in rehabilitation may stem from activation of premotor or supplementary motor areas.

Generator sources for the early and late ulnar hypothenar premotor potentials: Short segment electrophysiologic studies and cadaveric dissection

Objective: Determine the generator sources for the ulnar hypothenar premotor potentials (PMPs). Design: Observational. Setting: EMG laboratory. Subjects: Ten asymptomatic adult volunteers, three cadaver hands. Main Outcome Measure: Far-field versus near-field characteristics of recorded PMPs as determined by bipolar and referential recording electrode montages. A possible anatomic basis for any observed differences between ulnar PMPs and previously studied median PMPs was explored through cadaveric dissection. Results: An early PMP (E-PMP) had a latency that varied with changes in the position of G 1 only. A late PMP (L-PMP) was seen only when G 1 and G 2 were on different volumes (palm vs fifth digit, or second digit vs fifth digit); its latency did not vary significantly with changes in the position of G 1 and G 2. Conclusions: (1) E-PMP is a near-field potential generated by the ulnar nerve passing near the G 1 electrode. (2) L-PMP represents a far-field potential generated by the ulnar digital nerves as they traverse from the hand volume containing G 1 to the finger volume containing G 2. (3) Greater L-PMP-to-CMAP separation in the median than in the ulnar nerve was explained by cadaveric dissection, which revealed that the motor branch (responsible for the trailing CMAP) is longer in the median nerve than in the ulnar nerve relative to each nerve's corresponding digital sensory branch (responsible for the preceding L-PMP). (4) The PMP that is typically recorded with G 1 at the hypothenar motor point and G 2 on the fifth digit most likely represents E-PMP. (5) Any proposed diagnostic use of the ulnar PMPs must take into consideration these generator sources.

Detection of Iron Deficiency Anemia

<h3>To the Editor.</h3> — Iron deficiency is a common disorder in ambulatory subjects.^1,2While most such subjects are neither anemic nor symptomatic, even early iron deficiency reflects abnormal blood loss (usually due to bleeding) that requires medical attention. To screen such subjects for early iron deficiency rapidly, inexpensively, and accurately, serum transferrin saturation or ferritin values are too expensive. Since an isolated high red cell distribution width (RDW) has been shown to precede other blood count abnormalities during development of iron deficiency,³we studied the value of the automated blood cell count as a screening instrument in 783 unselected asymptomatic outpatient adult volunteers (57% women, 81% white, 19% black). Simultaneous serum ferritin, folate, and vitamin B₁₂levels were determined. The blood cell count was determined on a Coulter Counter S-Plus Sr (Coulter Electronics, Hialeah, Fla).⁴Iron deficiency was defined as a serum ferritin level of less

High prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic Hispanics

In this study, we estimated the prevalence of Helicobacter pylori infection and histologic gastritis in 58 asymptomatic Hispanic adult volunteers (mean age, 41 years; 59% male) by endoscopic biopsy of the upper gastrointestinal tract. Forty-six subjects (79%) were found to harbor H. pylori in gastric biopsies, and all had histologic gastritis. Four other subjects were found to have gastritis in the absence of H. pylori. Similar prevalences of H. pylori and gastritis were noted in all age groups and also in American-born and immigrant Hispanics. Biopsy data and serologic studies of H. pylori antibodies correlated well. We conclude that H. pylori infection is an almost universal finding in the gastric mucosa of asymptomatic adult Hispanics, regardless of age. The clinical significance of these findings is unknown, but we speculate that H. pylori and its associated gastritis could have a role in the high incidence of gastric carcinoma in Hispanic populations.

Nasal Carriage of Free-Living Amoebae

South Australia has had a relatively high frequency of human disease caused by free-living amoebae. The prevalence of these organisms in the nasal mucosa of 262 asymptomatic adult volunteers was determined. Acanthamoeba was isolated from six (2.3 per cent) subjects. This carriage rate is not high in comparison to other studies. Keywords: Free-living amoebae; Acanthamoeba ; Nasal mucosa; Keratitis; Normal flora.

The significance of intraepithelial eosinophils in the histologic diagnosis of gastroesophageal reflux.

Detection of intraepithelial eosinophils in esophageal mucosal biopsies has been suggested as histologic evidence of symptomatic gastroesophageal reflux (GER) disease in both children and adults. Previous studies have primarily examined symptomatic persons, and only one study included a comparison with normal controls. In the present study, the authors examined esophageal mucosal biopsies obtained by the hydraulic suction technic for the presence of intraepithelial eosinophils from 73 adult patients with subjective and objective evidence of GER disease and 12 asymptomatic adult volunteers in whom a series of esophageal function tests were normal. Intraepithelial eosinophils were identified in 23 (31.5%) of adult patients and in 4 (33.3%) of the asymptomatic volunteers. No clinical aspects in the GER patients correlated with the presence of eosinophils. By crude quantitation, rare eosinophils added little to more conventional assessment of histologic esophagitis and were present in one-third of normal subjects. The authors conclude that rare eosinophils in esophageal biopsies may not be a reliable criterion for the histologic assessment of GER disease.