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Biomedical subjects

E Nystrom

Publications and source records attributed to E Nystrom.

13 recordsLinked to original sources

Debilitating chronic pain syndromes after presumed intraneural injections.

This report presents seven patients with severe disability established at the time of a peripheral nerve block. In most of the cases, the injection was administered as a routine procedure by an experienced anesthesiologist. The patient histories suggest that the condition, which can be resistant to all treatment, in most cases could have been avoided if careful attention had been given to the occurrence of pain during the nerve block. It is likely that the risk of devastating iatrogenic disability can be minimized if a few basic principles are respected during the administration of peripheral nerve blocks.

Adult↗

A natural transactivation mutation in the thyroid hormone beta receptor: impaired interaction with putative transcriptional mediators.

The syndrome of resistance to thyroid hormone is characterized by elevated serum free thyroid hormones, failure to suppress pituitary thyrotropin secretion, and variable peripheral refractoriness to hormone action. Here we describe a novel leucine to valine mutation in codon 454 (L454V) of the thyroid hormone beta receptor (TR beta) in this disorder, resulting in a mutant receptor with unusual functional properties. Although the mutant protein binds ligand comparably to wild-type receptor and forms homo- and heterodimers on direct repeat, everted repeat, or palindromic thyroid response elements, its ability to activate transcription via these elements is markedly impaired. The hydrophobic leucine residue lies within an amphipathic alpha-helix at the carboxyl terminus of TR beta and the position of the homologous residue in the crystal structure of TR alpha indicates that its side chain is solvent-exposed and might interact with other proteins. We find that two putative transcriptional mediators (RIP140 and SRC-1) exhibit hormone-dependent association with wild-type TR. In comparison, the interaction of this natural mutant (L454V) and artificial mutants (L454A, E457A) with RIP140 and SRC-1 is markedly reduced. Furthermore, coexpression of SRC-1 is able to restore the transcriptional activity of the L454V mutant receptor, indicating that the interaction of this residue with accessory proteins is critical for transcriptional activation. Finally, the occurrence of the L454V mutation in resistance to thyroid hormone, together with impaired negative regulation of the thyroid-stimulating hormone alpha promoter by this mutant, suggests that the amphipathic alpha-helix also mediates hormone-dependent transcriptional inhibition, perhaps via interaction with these or other accessory factors.

Adaptor Proteins, Signal Transducing↗

Bone grafts and Brånemark implants in the treatment of the severely resorbed maxilla: a 2-year longitudinal study.

A combination of horseshoe-shaped iliac bone grafts and Brånemark implants was used in 30 patients with severely resorbed maxillary alveolar ridges. All patients were followed clinically for 2 years and evaluated with regard to prosthesis stability, fixture survival, wound healing complications, and soft tissue conditions. Surgery was performed by the same oral surgeons using identical procedures, and the prosthetic treatment was performed by the same prosthodontist. The development group included the first 10 patients and the routine group included the following 20. Fixture survival in the development group was 54.4%, whereas 88.3% of the fixtures in the routine group have survived after 2 years. The average fixture survival in the study was 77.4%. Three patients in the development group lost all fixtures, primarily the result of trauma to the grafted region. With respect to the difficult situation many of these patients experienced, the survival rate should be considered most acceptable.

Adult↗

Combined use of bone graft and Biotes fixtures in the treatment of the severely resorbed upper jaws.

Horse-shoe shaped bone grafts from the hip together with biotes self-tapping fixtures were used to rehabilitate patients with extremely resorbed upper jaws. Our experience and results from the 10 first consecutive case have been analyzed to form the base for further use of the method. We have lost eight fixtures out of 57 so far. Surgical complications with exposure of the bone transplant have occurred in three patients. A surprisingly good recovery from the hip has been seen in all of the patients. Certain technical precautions such as construction of a splint in the dentulous or partially dentulous jaw to prevent occlusal trauma towards the transplant have been made to avoid complications such as rupture of the mucosal flap. The method should be used with great care and the case meticulously chosen to avoid individuals who do not have the right motivation for the long-lasting and demanding surgical and prosthetic procedures. The combined use of implants and transplants should not be used routinely until a long-term evaluation of the method has been made to minimize potential drawbacks.

Adult↗

Radiographic study of structural changes in the temporomandibular joint after oblique sliding osteotomy: comparison between the extra-oral and intra-oral approaches.

Oblique sliding osteotomy of the mandibular rami was performed on 41 patients by either an intra-oral (21 patients) or extra-oral (20 patients) approach. The temporomandibular joints were radiographed preoperatively and then immediately and 18 months postoperatively. Signs of structural changes were recorded so as to compare the two approaches to osteotomy. The most common findings following the operation were signs of sclerosis and bone remodelling in 85% and 73% respectively of the two groups but these differences were not statistically significant.

Adolescent↗

Developing information-seeking skills in occupational therapy students.

This paper discusses the importance of teaching occupational therapy students methods for finding information in libraries. It details the efforts at Ohio State University to supply this instruction and demonstrates the positive results of library user education as seen by the instructors of occupational therapy students. This partnership between librarians and classroom instructors can easily be adapted to any health sciences education program.

Attitude of Health Personnel↗

Combined use of bone grafts and Brånemark fixtures in the treatment of severely resorbed maxillae.

Bone grafts from the hip in combination with Brånemark self-tapping fixtures have been used to rehabilitate patients with extremely resorbed maxillae. Experiences and results from the first ten consecutive cases have been analyzed to form the basis for further use of the method. Eight of 57 fixtures placed have been lost to date. Surgical complications, including exposure of the bone transplant, have occurred in three patients. The method should be used with caution, and cases should be meticulously chosen to exclude those who do not have proper motivation to endure the long-lasting and demanding surgical and prosthetic procedures required. The combined use of implants and transplants should not be used routinely until a long-term evaluation of the method and results has been made.

Bone Resorption↗

Long-acting analgesic or long-acting local anesthetic in controlling immediate postoperative pain after lower third molar surgery.

In a double-blind crossover study, the effect on postoperative pain of lidocaine plus diflunisal was compared with that of bupivacaine and placebo. Forty-eight patients with bilateral impactions of lower third molars had these removed on two occasions four weeks apart. One pain-control regimen was used on one occasion and the alternate on the second. The pain intensity was indicated on a visual analog scale at 2, 3, 4, 5, and 6 hours postoperatively. The pain values for the first postoperative hours were higher for the lidocaine diflunisal combination, whereas after 5 hours the opposite was true. Significantly more patients preferred the combination of lidocaine and diflunisal. Three patients reported fatigue postoperatively during the day of surgery, which they attributed to the operation and not to the analgesics used.

Adolescent↗