Symptom-free Volunteers Research Articles

Standard reference values of the upper body posture in healthy male adults aged between 31 and 40 years in Germany-an observational study

BackgroundIn order to classify and analyze the parameters of upper body posture, a baseline in the form of standard values is demanded. To this date, standard values have only been published for healthy men aged 18–35 and 41–50 years. Data for male adults aged between 31 and 40 years are lacking.MethodsThe postural parameters of 101 symptom-free male volunteers aged 31–40 (35.58 ± 2.88) years were studied. The mean height of the men was 179.89 ± 7.38 cm, with a mean body weight of 86.36 ± 11.58 kg and an average BMI of 26.70 ± 3.35 kg/m2. By means of video rasterstereography, a 3-dimensional scan of the upper back surface was measured in a habitual standing position. The means or medians, confidence interval, tolerance range, and group comparisons and correlations of BMI and physical activity were calculated for all parameters.ResultsThe habitual standing position was found to be almost symmetrical and the axis aligned in the spine, pelvis, and shoulder region, while the spine position was marginally inclined ventrally. The kyphosis angle of the thoracic spine was greater than the lordosis angle of the lumbar spine. All deviations fell under the measurement error margin of 1 mm/1°. The greater the BMI, the greater was the pelvic and scapular distance. The lower the BMI, the further caudally positioned was the right shoulder. The pelvic and scapular distances were also lower with the increasing athleticism of the participants.ConclusionThe upper body posture of men between the ages of 31 and 40 years was found to be almost symmetrical and axis-conforming, with the kyphosis angle, pelvic distance, and shoulder distance enlarging with increasing BMI. Consequently, postural parameters presented in this survey allow for comparisons with other studies, as well as the evaluation of clinical diagnostics and applications.

Standard reference values of the upper body posture in healthy middle-aged female adults in Germany

In order to classify and analyze the parameters of upper body posture, a baseline in form of standard values is demanded. To this date, standard values have only been published for healthy young women. Data for female adults between 51 and 60 years are lacking. 101 symptom-free female volunteers aged 51–60 (55.16 ± 2.89) years. The mean height of the volunteers was 1.66 ± 0.62 m, with a mean body weight of 69.3 ± 11.88 kg and an average BMI of 25.02 ± 4.55 kg/m2. By means of video raster stereography, a 3D-scan of the upper back surface was measured in a habitual standing position. The confidence interval, tolerance range and ICCs were calculated for all parameters. The habitual standing position is almost symmetrical in the frontal plane the most prominent deviation being a slightly more ventral position of the left shoulder blade in comparison to the right. The upper body (spine position) is inclined ventrally with a minor tilt to the left. In the sagittal plane, the kyphosis angle of the thoracic spine is greater than the lordosis angle of the lumbar spine. The pelvis is virtually evenly balanced with deviations from an ideal position falling under the measurement error margin of 1 mm/1°. There were also BMI influenced postural variations in the sagittal plane and shoulder distance. The ICCs are calculated from three repeated measurements and all parameters can be classified as "almost perfect". Deflections from an ideally symmetric spinal alignment in women aged 51–60 years are small-scaled, with a minimal frontal-left inclination and accentuated sigmoidal shape of the spine. Postural parameters presented in this survey allow for comparisons with other studies as well as the evaluation of clinical diagnostics and applications.

Validity and Reliability of the Satel 40 Hz Stabilometric Force Platform for Measuring Quiet Stance and Dynamic Standing Balance in Healthy Subjects.

Background: A force platform must have validity and reliability for optimal use. The objective of this study was to analyze the validity and the reliability of the Satel 40 Hz stabilometric force platform. Methods: A study of instrumental validity and reliability, involving a cross-sectional correlational and comparative analysis was performed. To determine the validity, four certified weights located on three axes were used and the ability of the stabilometric force platform to detect changes in the position of the different axes was observed. A test–retest was performed to analyze the reliability. Forty-two symptom-free volunteers participated in the study. Assessments were taken in a standing static position and in a dynamic position, with the eyes open and closed. Three measurements were taken and the intra-class correlation coefficient (ICC) was calculated. Results: The validity increased as the weight increased for all the variables measured in the stabilometric parameters (p < 0.05). The reliability was shown to be good to excellent for the two visual conditions. The positional variables obtained a higher ICC. The variable with the best ICC was the Y mean in OE (ICC 0.874 and a p < 0.001). All the values showed an increase in a dynamic situation. Conclusion: The findings support the reliability and validity of the Satel 40 Hz stabilometric force platform. The platform could be recommended to evaluate static and dynamic standing balance in healthy adult individuals. Guidelines for treatment and the level of quality of stabilometry could be obtained from its use.

Multiple diagnoses, increased kinesiophobia? - Patients with high kinesiophobia levels showed a greater number of temporomandibular disorder diagnoses

ObjectivesThe aim of this study was to empirically derive subgroups according to pain-related fear of movement beliefs using cluster analysis within a sample of TMD patients and asymptomatic volunteers. Methods129 volunteers participated in this cross-sectional study (34.78, standard deviation [SD]: 12.49 years; 92 TMD patients and 37 symptom-free volunteers). Mechanical pain sensitivity through pressure pain threshold (PPT) on orofacial and remote sites, kinesiophobia, pain catastrophizing, anxiety and depression were assessed. A cluster analysis was used to derive subgroups according to kinesiophobia scores (TSK/TMD). ResultsThree subgroups were derived: cluster 1 (high kinesiophobia [n = 53], TSK score: 33, SD[standard deviation] = 2.9), cluster 2 (moderate kinesiophobia [n = 50], TSK score: 26.2, SD = 2.14) and cluster 3 (no/low kinesiophobia [n = 26], TSK score 12.12, SD = 2.08) which included patients with higher overall PPT and lower scores on psychosocial variables. The group with high kinesiophobia showed high levels of pain catastrophizing, anxiety, and orofacial pain-related disability compared to the other subgroups and mechanical pain hyperalgesia in remote site compared to the low-kinesiophobia group. Also, we found a greater prevalence of triple diagnosis for the high-kinesiophobia subgroup compared to the moderate kinesiophobia group - odds ratio: 12.6 (95% confidence interval [CI]: 3.31–43.52, p < 0.01). ConclusionThese results suggested that patients with TMD and higher levels of kinesiophobia beliefs may show a more complex clinical feature, with high psychosocial distress, widespread mechanical pain sensitivity, and a more complex TMD disorder. In this way, we suggest a relationship between the number of TMD diagnoses and kinesiophobia severity.

Using a reference when defining an abnormal MRI reduces false-positive MRI results—a longitudinal study in two cohorts at risk for rheumatoid arthritis

The use of hand and foot MRI in the diagnostic process of RA has been advocated. Recent studies showed that MRI is helpful in predicting progression from clinically suspect arthralgia (CSA) to clinical arthritis, and from undifferentiated arthritis (UA) to RA. Symptom-free persons can also show inflammation on MRI. This study aimed to evaluate if MRI findings in symptom-free volunteers are relevant when defining a positive MRI. Two hundred and twenty-five CSA patients and two hundred and one UA patients underwent MRI of MCP, wrist and MTP joints at baseline and were followed for 1 year on progression to arthritis and RA, respectively, as reported previously. MRI was considered positive if ⩾ 1 joint showed inflammation (called uncorrected definition), or if ⩾ 1 joint had inflammation that was present in < 5% of persons of the same age category at the same location (called 5% corrected definition). Test characteristics were compared for both definitions. By using MRI data of symptom-free volunteers as reference, specificity of MRI-detected inflammation increased from 22 to 56% in CSA patients, and from 10 to 36% in UA patients. The sensitivity was not affected; it was 88 and 85% in CSA patients and 93 and 93% in UA patients. The accuracy also increased, from 32 to 60% in CSA patients and 22 to 44% in UA patients. The use of a reference population resulted in a substantial reduction of false-positive results, without influencing the sensitivity. Although common for other tests in medicine, this phenomenon is novel for MRI in the early detection of RA.

General Osteopathic Treatment is Associated with Postural Changes

Aim: To investigate whether standard general osteopathic treatment can influence the static configuration of the vertebral column or pelvis. Material and Methods: One hundred thirteen persons, 72 females and 41 males, either symptomfree volunteers or patients with mild idiopathic back pain, were investigated using the DIERS formetric® system, before and immediately after a single session of general osteopathic treatment. Variables of static assessment of the thoraco-lumbar vertebral column and of the pelvis were compared before and after treatment, using paired statistics. Results: There was no difference between observations in the healthy controls and the symptomatic patients. The sagittal imbalance decreased significantly (two sided student’s t-test: P=0.034), apical deviation diminished (one sided student’s t-test: P= 0.047) after treatment and lordotic apex position increased (one sided student’s t-test: P=0.028). Since such changes have not been observed in a previous trial of repeat measurements without treatment, the observations in the present study suggest an effect of treatment. This effect was, however, limited to persons Short Research Article Comhaire et al.; BJMMR, 6(7): 709-714, 2015; Article no.BJMMR.2015.247 710 with sagittal imbalance not exceeding the 62 percentile. Conclusion: General osteopathic treatment is associated with reduced sagittal imbalance and apical deviation and increased lordotic apex position, but this effect is demonstrable only in persons whose sagittal imbalance ranks in the lower or median tertile.

Refining the Reference Values of Diers 4D Formetric System and Introducing a Qualitative Spine Profile Based on Percentile Ranking

Background: In order to detect possible abnormalities of the spine posture of an individual patient, it is mandatory to dispose of adequate reference values based on measurements in a normal, symptom-free population. The Diers formetric system allows for non-invasive and accurate assessment of the vertebral column based on the registration of external aspect of the back surface using the Moire principle. Objective: To create a qualitative spine profile based on the percentile ranking of measurements obtained by the Diers formetric system taking into account possible confounding factors. Materials and Methods: Statistical analysis of formetric recordings in 216 symptom-free volunteers. Results: Maximal kyphotic angle, maximal scoliotic angle, sagittal imbalance, fleche cervicale, and pelvic inclination are significantly influenced by gender and by body mass index (BMI). A synoptic chart was created presenting the percentile ranking taking into account gender and BMI. The percentile ranking was summarized in both a table with colour code and depicted in a histogram of the individual’s Qualitative Spine Profile (QSP). Clinical Significance: Percentile ranking and the Quantitative Spine Profile taking into account gender and BMI should permit a more precise and reliable assessment of possible posture deviations related to the patient’s complaints, and may assist the therapist in selecting the best mode of treatment.

Stress analysis during jaw movement based on vivo computed tomography images from patients with temporomandibular disorders

The purpose of this study is to develop three-dimensional (3D) finite element models of temporomandibular joints (TMJs) and to investigate stress distributions. To determine the causes of temporomandibular disorders (TMDs), the magnitude and location of the maximum stresses under physiological loading must be considered. Stress analysis TMD models were reconstructed from computed tomography (CT) data. Several studies have investigated finite element TMJ models, but few have used a bilateral mandible model that includes jaw closing and maximum opening. In this study, the authors defined an asymmetry index for the different stress values on each side joint; this index has not yet been investigated. According to clinical observation, one joint affects the other side joint during mastication. Three symptom-free volunteers and three symptomatic patients were selected as the control group (CG) and TMD group (TG), respectively. For the TG, data analysis indicated that the condyle was asymmetrical during jaw closing, while both the condyle and disc were slightly asymmetrical during jaw opening. The maximum stresses did not significantly differ between the CG and TG for either closing or opening of the jaw. The results of this study have a potential clinical benefit in terms of proving superior biomechanical behaviour.

US findings for chronic lateral epicondylitis.

Purpose: To assess which individual gray-scale and color Doppler US findings and their combination are strongly associated with lateral epicondylitis. Also to determine whether chronic lateral epicondylitis is possible without any positive US findings.Methods: 49 patients (6 bilateral) underwent gray-scale ultrasonic imaging between 2005 to 2007. All had a history of lateral epicondylitis and had concordant pain during US probe compression in the common extensor region. Mean patient age was 47 (sd 7.7) years; M/F ratio 21/28; L/R ratio 17/32. Five symptom free volunteers (all bilateral) with a mean age of 36 (sd 8.7) years; M/F = 4/6; L/R = 5/5.Results: Neovascularity determined by color Doppler and four gray-scale US findings – a convex external contour, an erosive lateral epicondular cortex, internal calcifications, or a tear – have a specificity and PPV of 100% with conclusive likelihood ratios. However, only the sensitivity for neovascularity is above 50%. A combination of gray-scale and color Doppler shows a sensitivity between 92% to100%, a 90% specificity with a 98% PPV and a high likelihood ratio (9 to10).Conclusion: The combination of gray-scale and color Doppler changes is diagnostically superior to identify chronic lateral epicondylitis. Signs which confirm the diagnosis are a convex boundary, an erosive cortex, internal calcifications, a tear, and neovascularity. Patients with positive clinical signs and concordant pain but no US findings require further MRI evaluation.

The impact of hallux valgus on foot kinematics: A cross-sectional, comparative study

Background Hallux valgus is a very common foot deformity in modern societies. The impact of this condition on foot function has been described qualitatively and quantitatively. Published patho-mechanical models are mainly underpinned by findings originating from plantar pressure measurements. However, the kinematical patterns of the many foot segments during gait have not been quantified. This study aims to evaluate the kinematics of the various foot segments in the presence of this deformity. Methods Using the Oxford Foot Model and a 12-camera Motion Analysis System, gait analysis was conducted on a convenience sample of 20 participants with hallux valgus and compared to that of 22 randomly selected symptom-free volunteers. Differences between temporal and kinematical data between groups were analyzed using the unpaired parametric Student t-test (significance level p < 0.01). Results During specific gait events, a different range of motion was found at several inter-segment angles. Particularly, the range of motion of the hallux (sagittal plane) and hindfoot (frontal-transverse planes) during stance were significantly different ( p < 0.01). Conclusion Sagittal plane kinematics of the hallux is affected by the first ray deformity in this condition. However, the impact on other segments was found to be limited. This suggests that the patho-mechanical consequences remain limited to the weight bearing function of the first ray.

Infrared Thermography in the Assessment of Temporomandibular Joint Dysorder

Background: Temporomandibular joint disorder (TMD) is a group of musculoskeletal conditions characterized by pain in the pre-auricular area, limitation of jaw movement a nd palpable muscle tenderness. Thermography is a nonionizing, noninvasive diagnostic alternative for the evaluation of TMD. This study was conducted to evaluate the usefulness of thermography in the assessment of TMD. Methods: Thermography was conducted on the 61 patients who had been diagnosed with TMD, and on the 34 normal symptom-free volunteers. The temperature differences between opposite sides of the temporomandibular joint (ΔTTMJ) and the masseter muscle (ΔTMST ) were calculated. The sensitivity and specificity of thermography was calculated at the cut off values of 0.2, 0.3, and 0.4 o C. Results: In the patient group, the ΔTTMJ was 0.42 ± 0.38 o C and the ΔTMST was 0.38 ± 0.33 o C, whereas in the control group the ΔTTMJ was 0.10 ± 0.07 o C and the ΔTMST 0.15 ± 0.10 o C. In addition, the patient group demonstrated a significantly lower level of thermal symme try than the control group (P ＜ 0.001) in both the temporomandibular joints and the masseter muscles. The sensitivity of thermography at the cut off values of 0.2, 0.3 and 0.4 o C was 67.2, 49.2, and 42.6% in the temporomandibular joint (TMJ) and 60.7, 49.2 and 37.7% in the masseter muscle, respectively. The specificity of therm ography at the cut off values of 0.2, 0.3 and 0.4 o C was 88.2, 100, and 100% in the TMJ and 61.8, 91.2 and 100% in the masseter muscles, respectively. The accuracy of thermography at the cut off values of 0.2, 0.3 and 0.4 o C was 74.7, 67.4, and 63.2% in TMJ and 61.1, 64.2 and 60.0% in the masseter muscles, respectively. Conclusions: Temperature differences exist between the opposite sides of the TMD and masseter muscles in patients with TMD. Although the sensitivity of thermography in the diagnosis of TMD is low, it has high specificity in the evaluation of TMD, and is therefore applicable to patients with TMD. (Korean J Pain 2007; 20: 163�� 168)

Temporomandibular Joint Disk Position Assessed at Coronal MR Imaging in Asymptomatic Volunteers

To assess the normal position of the temporomandibular joint (TMJ) disk relative to the condyle by using coronal magnetic resonance (MR) imaging in asymptomatic volunteers. This study was approved by the review committee for human research, and all subjects signed an informed consent form. Thirty symptom-free volunteers without histories of TMJ disorders underwent standardized clinical examinations. Afterward, bilateral sagittal oblique and coronal oblique MR images were acquired with the patient's mouth opened and closed. The coronal oblique opened- and closed-mouth images were analyzed by using computer software. The medial and lateral edges of both the TMJ disk and the condyle were marked for these imaging examinations by using the section through the posterior 3 mm of the disk. To eliminate the effect of different magnifications and/or distortions, the distance between these points was measured automatically and divided by the largest mediolateral dimensions of the condyle. To assess the reliability of the measurements, four observers evaluated the position of the disk in the coronal plane. To assess the changes in position of the posterior 3 mm of the disk in the coronal plane in the closed- and opened-mouth positions, the Wilcoxon signed rank test for matched pairs was used. Interobserver measurement reliability was evaluated by using interclass correlation coefficients (ICCs). Analysis of the coronal closed-mouth disk position revealed a medial position of the TMJ disk relative to the condyle in 11 (21%) of 52 analyzed joints. In the opened-mouth position, the medial location of the disk was more frequent: 29 (85%) of 34 analyzed joints exhibited a medial position of the disk relative to the condyle in this plane. This increasingly medial position of the disk was statistically significant (P < or = .001). Measurement reliability assessment revealed sufficient results (ICC > or = 0.7). At both closed- and opened-mouth MR imaging, a medially located TMJ disk seems to be within the normal range of variation. The disk seems to shift even more medially when the mouth is opened.

Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers

Study design: Prospective MR analysis of the cervical spine of 30 asymptomatic volunteers. Objectives: To evaluate the prevalence of annular tears, bulging discs, disc herniations and medullary compression on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images of the cervical spine in symptom free volunteers. Summary of background data: Few studies have reported the prevalence of cervical disc herniations in asymptomatic people, none have reported the prevalence of cervical annular tears on MR images of symptom free volunteers. Materials and methods: Thirty symptom-free volunteers (no history or symptoms related to the cervical spine) were examined using sagittal T2-weighted fast spin-echo (SE), sagittal gadolinium-enhanced T1-weighted SE imaging and axial T2 *-weighted gradient echo (GRE). The prevalence of bulging discs, focal protrusions, extrusions, nonenhancing or enhancing annular tears and medullary compression were assessed. Results: The prevalence of bulging disk and focal disk protrusions was 73% (22 volunteers) and 50% (15 volunteers), respectively. There was one extrusion (3%). Eleven volunteers had annular tears at one or more levels (37%) and 94% of the annular tears enhanced after contrast injection. Asymptomatic medullary compression was found in four patients (13%). Conclusion: Annular tears and focal disk protrusions are frequently found on MR imaging of the cervical spine, with or without contrast enhancement, in asymptomatic population. The extruded disk herniation and medullary compression are unusual findings in a symptom-free population.

Microcirculatory changes parallel the clinical deterioration of chronic venous insufficiency

Objective: This study was designed to determine microcirculatory changes in patients belonging to different chronic venous insufficiency (CVI) classes. Methods: A total of 80 patients from all CVI classes and 15 symptom-free volunteers were studied prospectively. Venous reflux was verified with duplex scanning. Patients with conditions that may have affected the local microcirculation were excluded. Skin blood flux (SBF) was measured using a laser Doppler flowmeter in the supine position in a constant room temperature of 22°C and after 10 minutes acclimatization. The veno-arteriolar response (VAR) was estimated from the SBF change from supine to dependent position. The vasomotor activity (VMA) was determined from the baseline SBF.The amplitude of cycles (AC) and SBF during heat stress at 45°C were also measured. Results: Mean age, duration of disease and prevalence of deep vein thrombosis were greater in classes 4-6 compared with classes 1-3 ( P &lt;0.02). Although there was an increase in SBF and AC in classes 2 and 3 compared with the controls this was not significant. Values for SBF and AC were higher in classes 4-6 than classes 1-3 ( P &lt;0.01), and higher in class 6 than class 4 ( P &lt;0.01). Upon heating, the SBF increased more in classes 1-3 than in classes 4-6 ( P &lt;0.01), and in class 4 more than in class 6 ( P &lt;0.01). Values for VAR and VMA decreased with worsening of CVI, but these changes were not significant. Conclusions: Deterioration of the microcirculation is largely responsible for the clinical symptoms and signs seen in patients with CVI classes 4-6.

Three-dimensional finite element analysis of human temporomandibular joint with and without disc displacement during jaw opening

The aim of this study was to evaluate the differences of stress distribution in the temporomandibular joint (TMJ) disc during jaw opening between the subjects with and without internal derangement of TMJ (TMJ-ID). Three symptom-free volunteers and three symptomatic patients with anterior disc displacement were selected as normal and TMJ-ID subjects, respectively. For each subject, magnetic resonance images (MRI) were taken in the axial, sagittal and coronal directions. Using MRI taken, six three-dimensional finite element models of TMJ were developed. For each subject, the condylar movements during jaw opening were recorded and used as the loading condition for stress analysis. By comparing the calculated disc displacement to the measured one from MRI, the frictional coefficients were μ=0.001 for the normal subjects, but μ=0.01–0.001 for the TMJ-ID subjects. For the normal subjects, relatively high stresses were found at the anterior and lateral portions of the disc throughout jaw opening. In the connective tissues, the stress level was higher in the TMJ-ID than in the normal subjects. It is suggested that the disc displacement induces the change of stress distribution in the disc and the increase of frictional coefficients between articular surfaces, resulting in the secondary tissue damage.

The cyclothymic temperament in healthy controls and familially at risk individuals for mood disorder: endophenotype for genetic studies?

Background: The modern concept of affective disorders focuses increasingly on the study of subthreshold conditions on the border of manic or depressive episodes. Indeed, a spectrum of affective conditions spanning from temperament to clinical episodes has been proposed by the senior author. As bipolar disorder is a familial illness, an examination of cyclothymic temperament (CT) in controls and relatives of bipolar patients is of major relevance. Methods: We recruited a total sample of 177 healthy symptom-free volunteers. These controls were divided into three groups. The first one is comprised of 100 normal subjects with a negative familial affective history (NFH); the second of 37 individuals, with positive affective family history (PFH); and a third of 40 subjects, with at least one sib or first-degree kin with bipolar disorder type I according to the DSM-IV (BPR). The last two groups defined at risk individuals. We interviewed all subjects with CT, as described by the senior author. Results: We found a statistically significant difference in the rates of CT between the subjects in BPR versus others. CT was also more prevalent in the PFH compared with NFH. Additionally, the simple numeration of the CT traits exhibited gradation in the distribution of individuals inside the NFH, PFH and BPR. Finally, categorically defined CT and CT traits predominated in females. Limitation and conclusion: Although not all relatives of bipolar probands were studied, our results exhibit an aggregation of CT in families with affective disorder—and more specifically those with bipolar background. These results allow us to propose the importance of including CT for phenotypic characterization of bipolar disorder. Furthermore, our results support a spectrum concept of bipolar disorder, whereby CT is distributed in ascending order in the well-relatives of those with depressive and bipolar disorders. We submit that this temperament represents a behavioral endophenotype, serving as a link between molecular and behavioral genetics.

Evaluation of disc position in edentulous patients with complete dentures.

This study evaluated the condyle-disc relationship on magnetic resonance image (MRI) in a group of subjects with silent temporomandibular joints (TMJs) when tested clinically with those in subjects with discernible temporomandibular sounds. Study design Twenty-five completely edentulous patients were selected to participate in this study. The study was based on bilateral MRIs of 15 patients (with articular sound) and 10 symptom-free volunteers (control). It was noted that disc displacement was found in 45% of the TMJs with no history of articular sounds. In 6 TMJs of control group, a reducing disc displacement was found, and in 3 TMJs a permanent displacement was found. Disc displacements were identified in 70% of patients. Reducing disc displacement was found in 19 of these TMJs, whereas permanent displacement was found in 2 TMJs. In 9 of the joints of the symptomatic group, a superior disc position was found. Also verified was a significant association between reducing disc displacement and biconvex disc. These observations demonstrated that internal derangements can not be associated to clicking joints or symptoms of temporomandibular disorders in elderly edentulous patients, and the presence of displaced discs seems to be associated to altered disc morphology, but not to osseous abnormalities.

Symptoms, prostate volume, and urodynamic findings in elderly male volunteers without and with LUTS and in patients with LUTS suggestive of benign prostatic hyperplasia

Objectives. To estimate the differences in symptoms, prostate volume, and urodynamic variables of symptom-free elderly volunteers, volunteers with lower urinary tract symptoms (LUTS), and urologic patients with LUTS suggestive of benign prostatic hyperplasia. Methods. The study included 14 male volunteers without LUTS, 17 male volunteers with LUTS, and 565 urologic patients with LUTS who met the criteria of the International Consensus Committee on Benign Prostatic Hyperplasia. They were older than 50 years, they voided more than 150 mL during free uroflowmetry, their residual volume and prostate volume were estimated, and their American Urological Association symptom scores were collected. All men were also evaluated by urodynamic studies. Results. The prostate volume, residual volume, urethral resistance factor, and symptom scores were significantly lower and the maximal free flow rate and effective capacity significantly higher in the symptom-free volunteers than in the volunteers and patients with LUTS. Except for prostate volume, the variables in volunteers with LUTS closely approximated those of the patients with LUTS. The volunteers with LUTS had a smaller prostate volume than did the patients with LUTS. Nevertheless, the maximal free flow rate, symptoms, degree of obstruction, and prevalence of residual volume did not differ between the two groups. Men with an unstable bladder were present in all groups. Conclusions. Symptom-free volunteers had smaller prostate volumes, less residual volume, lower symptom scores, a lower urethral resistance factor, a higher maximal free flow rate, and a higher effective capacity than those with LUTS. Except for a smaller prostate volume, the findings in the volunteers with LUTS closely approximated those of the urologic patients with LUTS.

Morphology of the mandibular fossa and inclination of the articular eminence in patients with internal derangement and in symptom-free volunteers

Objective: The purpose of this study was to evaluate temporomandibular joint morphology and to compare possible structural variations in the temporomandibular joint anatomy of symptomatic anterior disk displacement patients with possible structural variations in the temporomandibular joint anatomy of symptom-free volunteers. Study Design: Fifty-six symptomatic patients and 25 symptom-free volunteers were included in this study. All subjects had bilateral high-resolution magnetic resonance imaging scans performed in the sagittal (closed and open) positions. Disk positions were evaluated with these images, and the patients were accordingly classified into 4 diagnostic groups. The angulation between the Frankfort horizontal plane and the posterior slope of the articular eminence, as well as the width and depth of the glenoid fossa and the articular tuberculum, were automatically measured with the aid of a computer. Results: The Mann-Whitney U test demonstrated significant differences in the angular and linear values obtained in disk displacement with reduction patients in comparison with the values obtained in patients with disk displacement without reduction and in symptom-free volunteers. Conclusion: It is proposed that a steeper posterior slope and higher tuberculum articulaire are predisposing factors for the development of disk displacement with reduction. Flattening of the eminence may progress in time, leading to the onset of disk displacement without reduction. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:98-107)

Detection of early lung cancer.

Background. The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience. Methods. ELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack-years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules. Findings. Noncalcified nodules were detected in 233 (23% [95% CI 21–26]) participants by low-dose CT at baseline, compared with 68 (7% [5–9]) by chest radiography. Malignant disease was detected in 27 (2.7% [1.8–3.8]) by CT and seven (0.7% [0.3–1.3]) by chest radiography, and stage I malignant disease in 23 (2.3% [1.5–3.3]) and four (0.4% [0.1–0.9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant noncalcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule. Interpretation. Low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common, they can be managed with little use of invasive diagnostic procedures. (Lancet 1999;354:99–105)