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7-1 Benefits of Touch and NFP, The Burnham Review    FREE Today

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7-4 NeuroAnatomy Study List for Manual Therapists, The Burnham Review

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Exudate, Fistulas, Transudate, Heterotopic Pancreas, Heterotopic Ossification and Manual Therapy on a Cellular Level References

Costoli, T., A. Bartolomucci, et al. (2004). "Effects of chronic psychosocial stress on cardiac autonomic responsiveness and myocardial structure in mice." Am J Physiol Heart Circ Physiol 286(6): H2133-40:   In summary, although mice appeared to adapt to chronic psychosocial stress in terms of acute cardiovascular responsiveness and heart rate rhythmicity, structural alterations occurred at the myocardial level.

Kinugasa, S., S. Tachibana, et al. (1998). "Idiopathic mediastinal fibrosis: report of a case." Surg Today 28(3): 335-8: We report herein the case of a 28-year-old woman who presented with a mediastinal mass, subsequently confirmed to be idiopathic mediastinal fibrosis.

Kitis, G., H. Thompson, et al. (1979). "Finger clubbing in inflammatory bowel disease: its prevalence and pathogenesis." Br Med J 2(6194): 825-8:  Finger clubbing, measured objectively by using the hyponychial angle, was present in 75 out of 200 (38%) patients with Crohn's disease, 15 out of 103 (15%) with ulcerative colitis, and two out of 24 (8%) with proctitis. In Crohn's disease and ulcerative colitis the hyponychial angle was significantly correlated with both disease activity and the extent of fibrosis in the resected specimens from 47 surgically treated patients. ...The focal stimuli for finger clubbing include mucosal inflammatory change and fibrosis mediated by the vagus and possibly other autonomic pathways acting as the afferent arc of a finger-clubbing reflex.

Mastai, R., L. Grande, et al. (1986). "Effects of metoclopramide and domperidone on azygos venous blood flow in patients with cirrhosis and portal hypertension." Hepatology 6(6): 1244-7:  The effects of pharmacological manipulation of the lower esophageal sphincter pressure on the esophageal circulation in patients with cirrhosis and portal hypertension were investigated in 33 patients by measuring the azygos venous blood flow, which is an index of blood flow through esophageal varices and periesophageal collaterals draining into the azygos venous system.

Parker, K. J. and R. M. Lerner (1992). "Sonoelasticity of organs: shear waves ring a bell." J Ultrasound Med 11(8): 387-92: Sonoelasticity is the use of ultrasonography to visualize, in real time, the hardness of stiffness of tissues and organs by depicting the tissue's motion in response to an applied vibration source. The applied vibration source is usually of low amplitude and low frequency (less than 0.1 mm displacement and less than 2000 Hz). Under these conditions, the natural vibration response of tissues and whole organs is revealed as a standing wave pattern determined by the low-frequency elastic constants of the tissues and their boundary conditions, factors that are not related to the ultrasonic echogenicity.

Smeets, M. B., G. Pasterkamp, et al. (2002). "Nitric oxide synthesis is involved in arterial haptoglobin expression after sustained flow changes." FEBS Lett 529(2-3): 221-4: The acute phase protein haptoglobin is highly expressed in arteries after sustained flow changes and involved in cell migration and arterial restructuring. In the liver, haptoglobin expression is mainly regulated by interleukin-6 (IL-6). In the artery, shear stress and NO influence IL-6 expression.
Treiber, G., A. Csepregi, et al. (2005). "The pathophysiology of portal hypertension." Dig Dis 23(1): 6-10: Portal hypertension is defined by an elevation in blood pressure in the portal system. Different causes are known and include a pre-, intra-, or posthepatic block. Portal hypertension is also classified according to the sinusoidal system. Portal hypertension will end up in the formation of collateral vessels. Varices can involve the whole gastrointestinal tract and are a frequent source of bleeding.

Florence Wong, MD, GI Division, Department of Medicine, University of Toronto, The Toronto Hospital:  Ascites is a common complication of liver cirrhosis. Its presence indicates a poor prognosis. Effective management of ascites eliminates the patient's risk for such life threatening complications such as spontaneous bacterial peritonitis and hepatorenal syndrome and improves patient well-being. Continued research into the pathophysiology of ascites formation in cirrhosis should lead to better understanding of the pathogenetic mechanisms and improved management of these patients.

Ninan, M., S. Hunter, et al. (1994). "Aortobronchial fistula following aortic valve surgery." J R Soc Med 87(9): 558-9:  We report the case of a 54-year-old man with an aortobronchial fistula following aortic valve replacement for prosthetic endocarditis. He presented with massive haemoptysis and the diagnosis was made following computerized tomography of the chest. Effective treatment was achieved by adhering to the basic principles of fistula management. The patient remains well at 1 year follow-up.

Oppenheimer, R. and L. Brotherton (2002). "Aortobronchial fistula: a rare etiology for hemoptysis." Ear Nose Throat J 81(4): 257-9:  Aortobronchial fistula is an extremely rare cause of hemoptysis. Aortobronchial fistula occurs in patients who have a history of thoracic vascular surgery. Because its symptoms are nonspecific, a high index of suspicion is critical if the physician is to detect it. The results of imaging studies (e.g., plain films, computed tomography, and angiography) and bronchoscopy are sometimes, but not always, diagnostic--another reason the diagnosis is difficult. Left untreated, mortality in patients with aortobronchial fistula is 100%. Patients can be salvaged by a variety of techniques, including the placement of an endovascular stent. We describe the case of a 52-year-old man who came to us with hoarseness and hemoptysis, which proved to be underlying symptoms of aortobronchial fistula. He was treated successfully.

Urschel, J. D. (1993). "The diagnostic importance of computed tomography in aortobronchial fistula--a case report." Angiology 44(10): 817-9:  Aortobronchial fistula secondary to thoracic aortic aneurysm is an unusual cause of hemoptysis. Computed tomography is the diagnostic procedure of choice. An illustrative case is reported.

Considerations

There are over 55,000 references to fistulas on Medline. The more unusual things found causing fistulas are bull’s horns and chicken bones (Ratliff, 1999), one of the most common causes noted in the literature was surgery.

A large number of fistulas are associated with the sigmoid sinus and other areas of the cranium. "The clinical features, imaging and angiographic findings of thirty four patients with cranial dural arteriovenous malformations and fistulae are presented in four groups. Group 1--Seven patients with anterior cavernous malformations, predominant superior ophthalmic vein drainage, and symptoms and signs of carotico-cavernous fistula. Group 2--Twelve patients with malformations of the superior petrosal, transverse and sigmoid sinus regions, presenting predominantly with bruit. Group 3--Seven patients with malformations of the basal sinuses and prominent cortical venous drainage, presenting with intracranial haemorrhage, headache and impaired cortical function. Intracranial haemorrhage never occurred in the absence of cortical venous drainage. Group 4--Eight patients with infrequent manifestations. Group 1 and 2 patients are readily recognized and diagnosed. Group 3 and 4 patients are often misdiagnosed. Treatment modalities comprised embolisation therapy, surgical excision, and carotid compression. Twenty patients were treated by one or more of these modalities with a successful outcome in thirteen patients. Group 1 patients are the most amenable to trans-arterial embolisation. Carotid compression as the sole modality of treatment was successful in four patients. Unless the fistula is successfully closed, Group 3 patients and patients who present with cervical or thoracic myelopathy carry a grave prognosis. There is need for greater radiologist awareness of Group 3 and the rarer presentations, particularly myelopathy. With the exception of one patient, the morphological features of our cases are consistent with the now-accepted view that these lesions are acquired arterio-venous fistulae and not congenital malformations." (ApSimmon, 1993).

Biliary stents and gallbladder or liver related surgeries were another common association with fistulas. "Perforation of the bowel during placement of a biliary stent is a known complication of this procedure....that ultimately led to a chronic colovaginal fistula" (Blake, 2004).

Many types of fistula are described in the literature, including an aorta-enteric. "The first patient had an aorto-sigmoid fistula in the setting of an aorto-bi-femoral graft. Two patients had a primary aorto-enteric fistula, one to the stomach from a suprarenal aortic aneurysm, and the other, to the duodenum in the setting of retroperitoneal spread of renal cancer. The aortoduodenal fistula recurred in the 4th patient within 3 months of surgical repair; this patient is the only one who survived long term. " ( Ramanujam, 2004).

References included a number of cases of fistulas after surgeries. "Empyemas developing after traumatic rupture of intraabdominal organs have been previously reported. We report a case of a true nontraumatic colopleural fistula following surgery for spontaneous rupture of a sigmoid diverticulum. The diagnosis was suspected by the presence of an air-containing tract seen in a computerized tomogram of chest and abdomen and was established with a contrast study. The empyema cavity was initially drained, followed by a laparotomy and fistulectomy with primary large bowel anastomosis and loop ileostomy " (Papagiannopoulos, 2004).

It is not unusual to see references to arteriovenous fistulas that also involve the cerebrospinal fluid system. "We reported a case of bleeding from the varix of a transverse-sigmoid sinus dural arteriovenous fistula with pure leptomeningeal drainage. A 55-year-old man presented with visual disturbance. neurological examination revealed left homonymous hemianopsia. CT scans demonstrated a subcortical hemorrhage in the right occipital lobe. Right external carotid angiograms showed a dural arteriovenous fistula of the transverse-sigmoid sinus fed by middle meningeal arteries and the occipital artery" (Yoshida, 2003).

The liver is often referred to in material on fistulas. "Biliary fistula often arises from liver hydatidosis itself, and can be partly attributed to erroneous operation on the part of the operators" (Peng, 2003).

In addition to surgery other traumas can contribute to fistulas. "The clinical record of 86 cases of traumatic nasal cerebrospinal fluid (CSF) fistula treated either surgically or conservatively between 1997 and 2001 was retrieved and analyzed. The fistula completely healed in 15 surgically treated patients (17.4%) and 71 conservatively treated patients (82.6%), and in the follow-up observation, recurrence was identified in none of the cases. Our experience approves the importance of head position, lowering intracranial pressure and application of antibiotics in the conservative therapy, and for surgical treatment, water-tight closure of the dura fistula should be performed" (Liao, 2003).

There can be other causes of arteriovenous fistulas. "A carotid cavernous fistula (CCF) is an abnormal arteriovenous anastomosis between the carotid artery and the cavernous sinus. Etiologies of this condition reported in the literature so far include facial trauma, rupture of an intracavernous aneurysm of the carotid artery, Ehler-Danlos syndrome and fibromuscular dysplasia of the cerebral arteries. Such fistulae were reported as complications of rhinoplasty, transsphenoidal surgery, embolization of cavernous sinus meningioma, and rhinocerebral mucormycosis. CCF may also occur spontaneously in children or as a congenital malformation. However, to our knowledge, submucous resection of the nasal septum has not been reported before to cause direct carotid-cavernous fistula. (Bizri, 2000).

The area of a fistula is more vulnerable to tumor growth, according to a number of articles. "Damaged mucosal sites seem to be vulnerable to tumor cell implantation. We describe a case of exfoliated tumor cells from a sigmoid colon cancer seeding a long-standing anal fistula (Hyman, 2003).

Some of the treatments of tumors can also lead to fistulas. "Osteoradionecrosis (ORN) of the craniomaxillofacial skeleton is a serious and debilitating complication that can occur following radiation therapy in the head and neck. The affected areas were the mandible (15 patients), the temporal bone (three patients), the maxilla (one patient), the cervical vertebrae (one patient) and the frontal bone (one patient). Clinical symptoms included pain, ulceration, a persistent draining fistula, exposure of bone or hardware, and pathological fracture or non-union of bone.....Conservative measures, such as limited debridement and HBO therapy, may be effective in preventing the progression of ORN. However, they fail to eradicate established ORN, which requires radical surgical resection followed by functional reconstruction with well-vascularised tissue" (Ang, 2003).

As well as involving soft tissue, there are some reports of fistulas in bony tissue. "Concerning these six cases, the authors recall the rarity of osseous localization of Hydatidiform disease, isolated as a rule, arising in the adult and preferentially involving the ilium, spinal column, femur, humerus and scapula. Being slowly progressive, the condition is revealed by pain, swelling and above all spontaneous fractures (long bones), or signs of root or medullary compression (spinal column), followed sometimes by fistula formation. Radiological diagnosis is often difficult with an osteolytic appearance without appreciable reactional osteogenesis. As for laboratory investigations, they are only of value in orientation; immunofluorescence being the weakest. The extent of osseous lysis frequently demands extensive surgery. From the anatomical standpoint, the hydatid variety of Echinococcosis has a specific intra-osseous development: beginning in the spongy bone, the architecture is intermediary between the hydatid appearance and the alveolar variety. Some cases however comprise a unilocular appearance with a suspicion of adventitial reaction. Extension into the soft parts frequently adopts a macroscopic appearance identical with that of visceral forms. Bony lysis is dependant on osteoclastic resorption or foci of necrosis while reactional osteogenesis is reduced. Medullary cellular reactions are determinant in the anatomical progress: osteitis or histiocyte and plasmodial reaction to the cuticle fragments."(Abelanet, 1975). There is also a report of a calcified hepatic arteriovenous fistula found after biopsy of the liver (Hurwitz, 2002).

References

1. Abelanet, R., Forest, M., Palangie, A., Meary, R., Tomeno, B., & Languepin, A. (1975). [Osseous echinococcosis. Apropos of 6 anatomo-clinical observations]. Ann Anat Pathol (Paris), 20(2), 133-148.

2. Ang, E., Black, C., Irish, J., Brown, D. H., Gullane, P., O'Sullivan, B., et al. (2003). Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton. Br J Plast Surg, 56(2), 92-99.

3. ApSimon, H. T., Ives, F. J., & Khangure, M. S. (1993). Cranial dural arteriovenous malformation and fistula. Radiological diagnosis and management. Review of thirty four patients. Australas Radiol, 37(1), 2-25.

4. Bizri, A. R., al-Ajam, M., Zaytoun, G., & al-Kutoubi, A. (2000). Direct carotid cavernous fistula after submucous resection of the nasal septum. ORL J Otorhinolaryngol Relat Spec, 62(1), 49-52.

5. Blake, A. M., Monga, N., & Dunn, E. M. (2004). Biliary stent causing colovaginal fistula: case report. Jsls, 8(1), 73-75.

6. Flaim, S. F. (1982). Peripheral vascular effects of nitroglycerin in a conscious rat model of heart failure. Am J Physiol, 243(6), H974-981.

7. Fransen, P., Mathurin, P., Pierre, P., Sindic, C., Thauvoy, C., & Stroobandt, G. (1993). Interest and necessity of combined neuroradiological and neurosurgical treatment in some cases of dural arterio-venous fistulae. Acta Neurochir (Wien), 121(1-2), 26-33.

8. Hinojosa, C. A., Plata-Munoz, J. J., Medina, H., & Takahashi, T. (2002). [Extracolonic manifestation as first sign of colorectal carcinoma. Report of 2 cases]. Rev Gastroenterol Mex, 67(4), 267-270.

9. Hyman, N., & Kida, M. (2003). Adenocarcinoma of the sigmoid colon seeding a chronic anal fistula: report of a case. Dis Colon Rectum, 46(6), 835-836.

10. Liao, W., Lin, S. H., & Huang, H. T. (2003). [Traumatic nasal cerebrospinal fluid fistula: report of 86 cases]. Di Yi Jun Yi Da Xue Xue Bao, 23(6), 629-630.

11. Pal, D. K., Bora, V., Bisoi, S. C., & Dwivedi, U. S. (2002). Urethrorectal fistula by bull horn injury. J Indian Med Assoc, 100(1), 47.

12. Papagiannopoulos, K., Gialvalis, D., Dodo, I., & Darby, M. J. (2004). Empyema resulting from a true colopleural fistula complicating a perforated sigmoid diverticulum. Ann Thorac Surg, 77(1), 324-326.

13. Peng, X. L., He, J. H., Li, Z. W., Peng, S. Z., Wang, X. F., & Zhao, S. Z. (2003). [Treatment and etiological analysis of biliary fistula associated with liver hydatidosis: report of 13 cases]. Di Yi Jun Yi Da Xue Xue Bao, 23(1), 73-74.

14. Ramanujam, S., Shiels, A., Zuckerman, G., & Prakash, C. (2004). Unusual presentations of aorto-enteric fistula. Gastrointest Endosc, 59(2), 300-304.

15. Ratliff, J., & Voorhies, R. M. (1999). Arteriovenous fistula with associated aneurysms coexisting with dural arteriovenous malformation of the anterior inferior falx. Case report and review of the literature. J Neurosurg, 91(2), 303-307.

16. Yoshida, H., Kaneko, Y., Ooasa, T., Ogasawara, S., Uozumi, Y., Kawano, T., et al. (2003). [A case of bleeding dural arteriovenous fistula of the transverse-sigmoid sinus with pure leptomeningeal drainage, varix: case report]. No Shinkei Geka, 31(6), 657-661.

Bone Marrow Edema

1. Gandapur, A. S., S. A. Malik, et al. (1997). "Bone marrow changes in human malaria: a retrospective study." J Pak Med Assoc 47(5): 137-9.

2. Holden, L. (1857). Human osteology : comprising a description of the bones : with delineations of the attachments of the muscles, the general and microscopic structure of the bone and its development : to which is added a brief notice of the unity of type in the construction of the vertebrate skeleton. London, John Churchill.

3. Matshes, E. W. (2004). Human osteology and skeletal radiology : [an atlas and guide]. Boca Raton, CRC Press.

4. White, T. D. and P. A. Folkens (2000). Human osteology. San Diego, Academic Press.

1. Foster, D. O., F. Depocas, et al. (1980). "Noradrenaline-induced calorigenesis in warm- and cold-acclimated rats: relations between concentration of noradrenaline in arterial plasma, blood flow to differently located masses of brown adipose tissue, and calorigenic response." Can J Physiol Pharmacol 58(8): 915-24.

2. Kalamkarova, M. V., N. V. Samosudova, et al. (1979). "[Complex biochemical and structural study of skeletal muscles in scoliosis]." Biofizika 24(1): 104-7.

3. Khaled, M. A., I. Kabir, et al. (1997). "Bioelectrical impedance measurements at various frequencies to estimate human body compositions." Indian J Exp Biol 35(2): 159-61.

4. Ma, S. W. and D. O. Foster (1989). "Brown adipose tissue, liver, and diet-induced thermogenesis in cafeteria diet-fed rats." Can J Physiol Pharmacol 67(4): 376-81.

5. Morimoto, Y., M. Sakata, et al. (2001). "[Effects of bofu-tsusho-san, a traditional Chinese medicine, on body fat accumulation in fructose-loaded rats]." Nippon Yakurigaku Zasshi 117(1): 77-86.

6. Ng, T. B., C. M. Wong, et al. (1986). "Insulin-like molecules in Momordica charantia seeds." J Ethnopharmacol 15(1): 107-17.

7. Woodward, J. A. and E. D. Saggerson (1986). "Effect of adenosine deaminase, N6-phenylisopropyladenosine and hypothyroidism on the responsiveness of rat brown adipocytes to noradrenaline." Biochem J 238(2): 395-403.

Belak, M., J. Kocisova, et al. (1977). "[Ultrastructural studies of mitochondria in striated muscles of birds with reference to experimental hypokinesis]." Arch Exp Veterinarmed 31(4): 537-46.

Electron microscopic studies have been carried out on the mitochondria of the transversely striated muscles with regard to experimental hypokinasis. As compared to the control group the mitochondria of m. pectoralis thoracicus and the m. iliotibialis posterior in hypokinetic birds reveal marked changes. In filamentous and ovoid mitochondria vacuoles can be observed which in some cases produced larger light formations with following disappearance of the cristae and destruction of mitochondria. Fat particles located at the poles of the altered mitochondria, sporadically occurring also laterally, presented another finding. The Z-lines of the sarcomer did not form a continuous line, but were somewhat shifted.

Blanchette-Mackie, E. J. and R. O. Scow (1982). "Continuity of intracellular channels with extracellular space in adipose tissue and liver: demonstrated with tannic acid and lanthanum." Anat Rec 203(2): 205-19.

Tannic acid was used to demonstrate continuity of intracellular channels with extracellular space in white adipose tissue of adult rats, brown adipose tissue of suckling rats, and liver of diabetic rats. Electron-opaque material resulting from treatment of glutaraldehyde-fixed tissue with tannic acid was found in extracellular space, invaginations of cell surfaces, vesicles, and intracellular channels. Electron-opaque material was present in channels that surrounded lipid droplets in both white and brown adipocytes and in hepatocytes. The small distance between the lumen of marked channels and lipid droplets in adipocytes indicates that a monolayered structure, perhaps a leaflet of membrane lining the channel. Similar findings were obtained in brown adipose tissue using lanthanum instead of tannic acid to mark intracellular channels continuous with extracellular space. Since endoplasmic reticulum is the primary site of triacylglycerol synthesis in adipocytes, marked channels near lipid droplets may be elements of endoplasmic reticulum. Some of the channels marked with tannic acid in hepatocytes contained lipoprotein particles, whereas others were located, in relation to mitochondria and lipid droplets, in the same sites as endoplasmic reticulum in untreated tissue. This indicates that some of the channels marked with tannic acid in hepatocytes are endoplasmic reticulum. Presence of electron-opaque material in intracellular channels and vesicles, but not in cytoplasm, of treated tissue indicates the channels and vesicles were open to extracellular space during treatment with tannic acid or lanthanum and, furthermore, that their membranes were continuous with plasma membrane.

Clarke, B. E., D. J. Brown, et al. (1983). "Gelatinous transformation of the bone marrow." Pathology 15(1): 85-8.

A case of gross macroscopic gelatinous transformation of bone marrow associated with prolonged malabsorption due to celiac disease is reported. Histochemical studies support the view that the extracellular myxoid tissue is composed predominantly of acid mucopolysaccharides, and electron microscopy shows extracellular fine fibrillar and granular material. The replacement of marrow in this condition is histochemically different from serous fat atrophy occurring in epicardial fat, and it is suggested that it results from an increase in normal ground substance. It must be differentiated from metastatic signet ring adenocarcinoma.

Clarke, L., M. J. Bryant, et al. (1997). "Maternal manipulation of brown adipose tissue and liver development in the ovine fetus during late gestation." Br J Nutr 77(6): 871-83.

We examined the effect of maternal chronic cold exposure, induced by winter-shearing ewes 4 weeks before their predicted lambing date, on brown adipose tissue (BAT) and liver development in lambs. Fetuses were sampled from under-fed (60% of energy requirements for maintenance and pregnancy of an unshorn ewe) shorn or unshorn ewes at 126, 140 and 145 d of gestation. Lambs were sampled from ewes within 2 h of birth. Throughout gestation fetal body, BAT and liver weights were similar in shorn and unshorn groups. The level of GDP binding to mitochondrial uncoupling protein remained low throughout gestation, but increased dramatically after birth. Lambs born to shorn ewes possessed more mitochondrial protein and exhibited a significantly higher total thermogenic activity in BAT. Type I iodothyronine 5' deiodinase (EC 3.8.1.4) activity in BAT peaked at birth, as did hepatic iodothyronine 5' deiodinase activity and was significantly greater in lambs born to under-fed shorn ewes, which exhibited a higher plasma triiodothyronine concentration. Chronic maternal adaptations to prolonged cold exposure appear to enable pregnant ewes to compensate for the negative effects of under-feeding on fetal growth and development.

Crowell, T. (2005). "The relationship between bone bruises and lymphedema after fracture: a case study." Townsend Letter for Doctors and Patients Jan(from http://www.findarticles.com/p/articles/mi_m0ISW/is_258/ai_n8592733).

Bone bruises of the tibia have been extensively studied using MRI technology. It is now verified that bone bruising is a common injury accompanying meniscal, ligamentous, and other injuries. (3,4,6) This case study presents bone bruising that occurred throughout the tibia along with an occult fracture of the lower tibia and fibula. There was also bruising of the fibula to a lesser degree. Significant lymph tissue involvement caused secondary problems with edema, as well as pain. This paper will look at lymph involvement secondary to bone bruising and the relationship between the two.

The subject underwent open reduction and internal fixation following a fall from a mountain bike. Correction of bony alignment and fixation of the tibia was provided by a rod secured by four screws. The fibula was not corrected. (See Figures 1 and 2).

The subject presented for treatment 4 weeks after the surgery. Initial assessment indicated a significant loss of normal ankle range of movement into dorsi-flexion of about 20 degrees less than a 90 degree angle. (See Figure 3) There was also a loss of plantar-flexion of about 20 degrees. Subtalar mobility was normal.

Divakaran, P. and A. Venkataraman (1977). "Effect of dietary fats on oxidative phosphorylation and fatty acid profile of rat liver mitochondria." J Nutr 107(9): 1621-31.

Hydrogenated coconut oil or safflower seed oil were fed at 20% levels to weanling male albino rats for 2 months. The fatty acid patterns of the liver homogenates, mitochondria and the microsomes were determined by gas chromatography as were also the fatty acid patterns of the liver cholesterol esters and the phospholipids. The mitochondrial phospholipids were fractionated by thin layer chromatography and the fatty acid moieties of the individual phospholipids were screened on a gas chromatograph. The oxidative phosphorylation in the liver mitochondria was determined using glutamate, malate and succinate as substrates. The liver fatty acid pattern, especially that of the subcellular particles, seemed to be dependent upon the dietary fat. The fatty acid composition of the mitochondrial phospholipids varied with the dietary fat. Oxidative phosphorylation for glutamate and malate was higher in the group fed safflower oil compared to that in the group fed saturated fat; in the case of succinate, no such difference was noticed. These results suggest that the changes in the phosphorylation capacity are due to the changes in the mitochondrial phospholipids which reflect the composition of the dietary fat.

Foster, D. O., F. Depocas, et al. (1980). "Noradrenaline-induced calorigenesis in warm- and cold-acclimated rats: relations between concentration of noradrenaline in arterial plasma, blood flow to differently located masses of brown adipose tissue, and calorigenic response." Can J Physiol Pharmacol 58(8): 915-24.

Barbital-sedated, warm-acclimated (WA) or cold-acclimated (CA) rats were infused intravenously with noradrenaline (NA) at doses that elicited graded calorigenic responses. Blood flow (Q) to the various bodies of brown adipose tissue (BAT), the major sites of the NA-induced calorigenesis, was measured with labeled microspheres. The O2 content of arterial blood and of venous blood from interscapular BAT and the concentration of NA in arterial plasma (ANA) were also determined. ANA was linearly related to the dose of NA. Calorigenic response and the Q of total BAT and of separate bodies of BAT were sigmoid functions of ANA. The threshold for calorigenic response or for increased flow to BAT was an ANA of about 2 ng/mL (12 nM), except for some bodies of BAT in CA rats where it was closer in 4 ng/mL. Delivery of O2 to total BAT and calorigenic response were related linearly. The bodies of BAT were heterogeneous in Q per gram in CA rats the hierarchy in Q per gram changed markedly as ANA and calorigenic response increased. The analysis of these results takes into account that calorigenesis in BAT normally is not mediated by circulating NA, that in NA-infused rats neuronal and extraneuronal uptakes of NA would effect a lower concentration of NA at the adrenoceptors of BAT than in circulation, and that many factors such as organization and density of adrenergic innervation and the number of efficacy of receptors must have contributed to determining the measured responses of BAT. It is concluded that the differently located bodies of BAT in rats may have significant differences in composition and structure and that they may undergo differential development during cold acclimation.

Foster, D. O., F. Depocas, et al. (1980). "Effects of rate of blood flow on fractional extraction and on uptake of infused noradrenaline by brown adipose tissue in vivo." Can J Physiol Pharmacol 58(10): 1212-20.

The rate of blood flow (Q) to interscapular brown adipose tissue (IBAT) and the arteriovenous difference in plasma noradrenaline (NA) across the tissue were measured in warm-acclimated (WA) or cold-acclimated (CA) rats during infusion of NA at doses of 1-12.5 ng min-1 g-0.74 (approximately 0.2-2.7 micrograms min-1 kg-1) and in the period of steady calorigenic response associated with steady concentration of NA in arterial plasma (ANA). ANA was linearly related to the dose of NA. Calorigenic response, percentage of cardiac output to IBAT, and Q per gram of IBAT were sigmoid functions of ANA and at their maxima were about 2.5 times greater in CA than in WA rats. The rate of uptake of NA by IBAT increased with ANA and Q, each of which had a major influence on rate, but the coefficient of extraction of NA by the tissue (ENAIBAT) declined. Measurements in rats given a dose of propranolol that partially inhibited the NA-induced increase in Q to IBAT indicated that the decline in ENAIBAT was attributable primarily to the increase in Q rather than to increasing saturation of uptake mechanisms. Diffusion-limited extraction of NA is the probable basis for the effect of Q on ENAIBAT. Possible implications of flow-dependent extraction of NA in studies involving measurements of the uptake of exogenous NA by tissues or organs are discussed.

Giammatteo, T. and S. Weiselfish-Giammatteo (1997). Integrative manual therapy for the autonomic nervous system and related disorders : utilizing advanced strain and counterstrain technique. Berkeley, Calif., North Atlantic Books.

Hall, B. K. and C. A. Squier (1982). "Ultrastructural quantitation of connective tissue changes in phenytoin-induced gingival overgrowth in the ferret." J Dent Res 61(7): 942-52.

The gingival overgrowth obtained after maintaining ferrets on PHT appeared to be due entirely to the effect of the drug, for inflammation induced by banding had no influence on the action of PHT in eliciting the overgrowth. The significant change observed was an increase in relative volume of interstitial material (ground substance) in response to PHT. Although there was no appreciable alteration in numbers of cells present in the lesion, PHT had a significant effect on the ultrastructure of fibroblasts. These cells showed a decrease in the relative volume of phagosomes, although organelles concerned with synthesis (the rough endoplasmic reticulum and Golgi zones) were not affected. This suggests that the relative increase in ground substance may reflect decreased breakdown of extracellular material within fibroblasts, while synthetic activity is maintained at a constant level. As a consequence, there is an increase in connective tissue volume--an increase which is manifested as an overgrowth.

Kalamkarova, M. V., N. V. Samosudova, et al. (1979). "[Complex biochemical and structural study of skeletal muscles in scoliosis]." Biofizika 24(1): 104-7.

Structural study of human scoliosis muscles showed significant dystrophic and degenerative changes: desintegration of fibrillar structure and striation; the Zencker necrosis; the replacement of muscular tissue by connective and adipose tissues. The electron microscopic observation revealed disordering of filamental array of the sarcomere (I- and A-discs), the broadening of Z-disc material, the appearance of N-stripes in I-band. At the same time deviations from the norm were observed in contractile proteins: actin and myosin. ATPase activity of myosin decreased by 25--30%; the flow of birefringence of myosin and especially of actin also decreased. Actin from the scoliosis muscles partially or completely lost the ability for polymerization in 0.1 M KC1.

Kenan, Y., M. Levinson, et al. (1997). "Adenylyl cyclase inhibitory pathway is differentially modified in rat white and brown fat by high-energy diets." Am J Physiol 272(6 Pt 1): E1043-9.

Incubation of white adipose tissue (WAT) adipocytes from rats fed a high-energy diet (Exp group) with antilipolytic Gi-coupled adenylyl cyclase inhibitory agonists, nicotinic acid (Nic) and N8-(L-2-phenylisopropyl)adenosine (PIA), resulted in lower cellular adenosine 3',5'-cyclic monophosphate (cAMP) levels than in stimulated adipocytes from rats fed a nutritionally balanced diet (Con group). In contrast to WAT, incubation of brown adipose tissue (BAT) adipocytes with Nic yielded higher cAMP levels in the Exp vs. Con rats. In both WAT and BAT adipocytes, pertussis toxin treatment abolished the differences in Nic- and PIA-inhibited cAMP formation between Exp and Con animals. Immunoblotting of adipocyte membranes indicated a lower content of Gi alpha but not Gs alpha in BAT membranes of Exp vs. Con animals after 6 and 10 wk of feeding. No such differences were found in the Gs alpha or Gi alpha contents of WAT membranes. Thus the inhibitory pathway of adenylyl cyclase is proposed to be sensitized in WAT and desensitized in BAT of rats fed high-energy diets. These modifications in sensitivity are in line with reduced cAMP and lipolysis in WAT and increased cAMP and thermogenesis in BAT during obesity.

Khaled, M. A., I. Kabir, et al. (1997). "Bioelectrical impedance measurements at various frequencies to estimate human body compositions." Indian J Exp Biol 35(2): 159-61.

Bioelectrical impedance analyses (BIA) operating at various frequencies were used to estimate body composition parameters and compared with the biochemically determined parameters by using isotopic dilution method in 22 healthy adult (30-50 years old) male human subjects. BIA instruments, operating at 50,100 KHz and 5 to 500 KHz range, were used to measure body compositions, namely total body water (TBW), fat free mass (FFM), and fat mass (FM). TBW of these subjects was also determined by deuterium dilution method. BIA methods measured at 100 KHz and using multifrequencies appear to be more accurate than at 50 KHz when compared with isotopic dilution method as standard. This accuracy could be attributed due to measurements made at higher frequencies that falls in the region where current passes through both extra- and intracellularly, thereby giving an appropriate measure of TBW. All the subjects participated in this study belong socioeconomically to the middle class and do not apparently look obese or fatty. However, the mean of their body fat, as estimated by the standard deuterium dilution method, was about 30% which is suggestive of an unapparent obesity prevailing in this class of people in Bangladesh.

Lunn, L. (2005). "The use of Integrative Manual Therapy to improve muscle function in clients with SCI." Journal of Integrative Manual Therapy Fall(1).

Ma, S. W. and D. O. Foster (1989). "Brown adipose tissue, liver, and diet-induced thermogenesis in cafeteria diet-fed rats." Can J Physiol Pharmacol 67(4): 376-81.

Diet-induced thermogenesis (DIT) in young rats overeating a "cafeteria" (CAF) diet of palatable human foods is characterized by a chronic, propranolol-inhibitable elevation in resting metabolic rate (VO2) and is associated with various changes in brown adipose tissue (BAT) that have been taken as evidence for BAT as the effector of DIT. But direct evidence for participation of BAT in DIT has been lacking. By employing a nonocclusive cannula to sample the venous effluent of interscapular BAT (IBAT) for analysis of its O2 content and measuring tissue blood flow with microspheres, we accomplished direct determination (Fick principle) of the O2 consumption of BAT in conscious CAF rats. In comparison with normophagic controls fed chow, the CAF rats exhibited a 43% increase in metabolizable energy intake, reduced food efficiency, a 22% elevation in resting VO2 at 28 degrees C (thermoneutrality) or 24 degrees C (housing temperature), and characteristic changes in the properties of their BAT (e.g., increased mass, protein content and mitochondrial GDP binding). They also exhibited the greater metabolic response to exogenous noradrenaline characteristic of CAF rats and the near elimination by propranolol of their elevation in VO2. By the criterion of their elevated VO2, the CAF rats were exhibiting DIT at the time of the measurements of BAT blood flow and blood O2 levels. However, BAT O2 consumption was found to be no greater in the CAF rats than in the controls at either 28 or 24 degrees C. At 28 degrees C it accounted for less than 1% of whole body VO2; at 24 degrees C it increased to about 10% of overall VO2 in both diet groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Malatesta, M., S. Battistelli, et al. (2001). "Fine structural modifications of liver, pancreas and brown adipose tissue mitochondria from hibernating, arousing and euthermic dormice." Cell Biol Int 25(2): 131-8.

An ultrastructural and morphometric study was performed on mitochondria of euthermic, hibernating and arousing hazel dormice (Muscardinus avellanarius), in order to investigate possible modifications during the seasonal cycle. Hepatocytes, pancreatic acinar cells and brown adipocytes were considered. Our results demonstrated that: (1) the general morphology of mitochondria of all cell types shows slight modifications during the seasonal cycle; (2) mitochondrial size and inner membrane length significantly increase from euthermia to hibernation and decrease upon arousal in all cell types; (3) mitochondrial matrix granules drastically increase in number during hibernation and decrease upon arousal in hepatocytes and pancreatic acinar cells, whereas they do not change in brown adipocytes. These structural modifications are probably related to the changes in cellular energy needs during the euthermia-hibernation-arousal cycle.

McCormack, J. G. and R. M. Denton (1980). "Role of calcium ions in the regulation of intramitochondrial metabolism. Properties of the Ca2+-sensitive dehydrogenases within intact uncoupled mitochondria from the white and brown adipose tissue of the rat." Biochem J 190(1): 95-105.

1. Increasing concentrations of both Ca2+ and Sr2+ (generated by using EGTA buffers) resulted in 4-fold increases in the initial activity of pyruvate dehydrogenase within intact uncoupled mitochondria from rat epididymal adipose tissue incubated in the presence of the ionophore A23187, ATP, Mg2+ and oligomycin. The k0.5 values (concentrations required for half-maximal effects) for Ca2+ and Sr2+ were 0.54 and 7.1 microM respectively. In extracts of the mitochondria, pyruvate dehydrogenase phosphate phosphatase activity was stimulated about 4-fold by Ca2+ and Sr2+, with k0.5 values of 1.08 and 6.4 microM respectively. 2. NAD+-isocitrate dehydrogenase and oxoglutarate dehydrogenase appeared to be rate-limiting in the oxidation of threo-Ds-isocitrate and oxoglutarate by uncoupled mitochondria from brown adipose tissue of cold-adapted rats. Ca2+ (and Sr2+) diminished the Km for the oxidation of both threo-Ds-isocitrate and oxoglutarate. The kinetic constants for these oxidations were very similar to those obtained for the activities of NAD+-isocitrate dehydrogenase and oxoglutarate dehydrogenase in extracts of the mitochondria. In particular, the k0.5 values for Ca2+ were all in the range 0.2--1.6 microM and Sr2+ was found to mimic Ca2+, but with k0.5 values about 10 times greater. 3. Overall, the results of this study demonstrate that the activities of pyruvate dehydrogenase, NAD+-isocitrate dehydrogenase and oxoglutarate dehydrogenase may all be increased by Ca2+ and Sr2+ within intact mitochondria. In all cases the k0.5 values are close to 1 and 10 microM respectively, as found for the separated enzymes. Experiments on brown-adipose-tissue mitochondria incubated in the presence of albumin suggest that it may be possible to use the sensitivity of the dehydrogenases to Ca2+ as a means of assessing the distribution of Ca2+ across the mitochondrial inner membrane.

McMahon, K. K. and R. J. Schimmel (1982). "Apparent absence of alpha-2 adrenergic receptors from hamster brown adipocytes." Life Sci 30(14): 1185-92.

The possible presence of alpha adrenergic control of lipolysis and cyclic AMP production in brown adipocytes of hamsters was studied in adipocytes isolated from interscapular, subscapular, cervical and axillary regions of normal male hamsters maintained at 25 degrees C. Lipolysis activated by either 3-isobutyl-l-methyl xanthine or isoproterenol was unaffected by the presence of the alpha adrenergic selective agonists clonidine and methoxamine. Similarly, accumulation of cyclic AMP in response to beta-receptor stimulation, alone or in combination with a methyl xanthine, was unaffected by clonidine or methoxamine. In contrast, both lipolysis and cyclic AMP accumulation in brown fat cells were effectively suppressed in the presence of nicotinic acid, prostaglandin E1 or N6-phenylisopropyl adenosine. Accumulation of cyclic AMP in response to the mixed agonist norepinephrine was not influenced when cells were exposed to the alpha adrenergic blocking drugs yohimbine or tolazoline. These observations suggest that alpha-2 adrenergic receptors which are present on hamster white fat cells and control production of cyclic AMP and lipolysis are absent from hamster brown adipocytes. On the other hand, brown fat cells of this species appear to respond to a number of other inhibitory compounds in a manner not markedly different from that of white adipocytes.

Morimoto, Y., M. Sakata, et al. (2001). "[Effects of bofu-tsusho-san, a traditional Chinese medicine, on body fat accumulation in fructose-loaded rats]." Nippon Yakurigaku Zasshi 117(1): 77-86.

The effects of Bofu-tsusho-san (BOF), a traditional Chinese medicine, on fructose-induced hypertriglyceridemia and body fat accumulation were investigated in female SD rats. Rats were allowed to drink ad libitum 25% (w/w) fructose solution for 6 weeks. BOF was administered to the rats as an experimental diet containing 1.5% or 4.5% (w/w) of BOF during the fructose-loading period. BOF suppressed body weight gain and prevented the elevation of serum triglyceride levels and body fat accumulation in fructose-loaded rats without affecting food and fructose intake. Furthermore, BOF prevented the increase of triglyceride content in the liver and the reduction of mitochondrial cytochome c oxidase activity in the brown adipose tissue induced by fructose. From these results, it has been suggested that BOF has a preventive effect against the body fat accumulation caused by excess intake of sugar or other fructose-containing foods. The inhibition of triglyceride synthesis in the liver, and the enhancement of lipolysis in adipocytes and of thermogenesis in brown adipose tissue have been presumed as the mechanisms of action of BOF.

Ng, T. B., C. M. Wong, et al. (1986). "Insulin-like molecules in Momordica charantia seeds." J Ethnopharmacol 15(1): 107-17.

Decorticated Momordica charantia seeds were extracted and processed by a method which was developed originally for the purification of insect and annelid insulins. Essentially, the method entailed HCl--ethanol extraction, neutralization with NH4OH, gel filtration on Sephadex G-50, ion exchange chromatography on CM Sepharose CL-6B and desalting on Sephadex G-10. Of the seven fractions collected, three fractions were obtained with antilipolytic and lipogenic activities in isolated adipocytes and one fraction with only lipogenic activity. The data indicate that molecules with insulin-like bioactivity are present in Momordica charantia seeds.

Sakaguchi, T. and M. Yamazaki (1988). "Hepatic portal injection of glucose elevates efferent sympathetic discharges of interscapular brown adipose tissue." Exp Neurol 101(3): 464-9.

Efferent sympathetic discharges of interscapular brown adipose tissue were recorded after three different concentrations of glucose (138, 277, and 416 mM) and 154 mM NaCl were injected into the portal vein or into the right jugular vein. When injected into the portal vein there was a significant increase in the discharge in response to both concentrations of glucose (277 and 416 mM), whereas only 416 mM glucose solution could cause an increase in the discharge when injected into the right jugular vein. There was no appreciable change in the discharge following the NaCl injections into the portal and jugular veins, and the portal glucose responses in the discharge were abolished by transection of the hepatic branch of the vagus nerve. Since stimulated sympathetic activity has been shown to elevate thermogenesis of the adipose tissue, these findings suggest that vagal glucose signals derived from the portal vein may be involved in the regulation of heat production of this tissue.

Weiselfish-Giammatteo, S. and T. Giammatteo (2002). Elimination Diet A New Health Care Tool. Bloomfield, CT, ANA Publishing.

Wheeler, L. (2004). "Advanced Strain Counterstrain." Massage Therapy Journal 43 Winter(4): from http://www.amtamassage.org/journal/winter05_journal/mtjWinter05.html.

Learn how this gentle approach can ease clients’ protective muscle spasms. from http://www.amtamassage.org/journal/winter05_journal/mtjWinter05.html

Woodward, J. A. and E. D. Saggerson (1986). "Effect of adenosine deaminase, N6-phenylisopropyladenosine and hypothyroidism on the responsiveness of rat brown adipocytes to noradrenaline." Biochem J 238(2): 395-403.

Adenosine deaminase (1 unit/ml) potentiated the lipolytic action of noradrenaline in adipocytes isolated from brown adipose tissue of 1- and 6-week-old rats by decreasing the EC50 (concn. giving 50% of maximal effect) for noradrenaline by 3-4-fold. With cells from neonatal rabbit tissue, adenosine deaminase only had a small, non-significant, effect on the EC50 for noradrenaline. Lipolysis in rat brown adipocytes was inhibited by low concentrations of N6-phenylisopropyladenosine (PIA). Rabbit cells were far less sensitive to PIA. PIA, prostaglandin E1 and nicotinate all inhibited noradrenaline-stimulated respiration in rat brown adipocytes. Hypothyroidism diminished the maximum response of respiration and lipolysis to noradrenaline in rat cells and increased the EC50 for noradrenaline. Responsiveness of lipolysis to noradrenaline was particularly decreased in hypothyroidism and was partially restored by addition of adenosine deaminase. Lipolysis in cells from hypothyroid rats was more sensitive to the anti-lipolytic action of PIA. Bordetella pertussis toxin increased lipolysis in the presence of PIA, suggesting an involvement of the Ni guanine-nucleotide-binding protein in the control of brown-adipocyte metabolism.

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Some Information on Exudate and the Pancreas (An excerpt from Merck's Manual)

About evidence of infection and exudate......... "Typically mononuclear cells and neutrophils infiltrate the exudate. (Merck) Pancreatitis can cause an exudate that at first is retroperitoneal but soon involves the peritoneal cavity. It is a chemical peritonitis, initially with a high level of amylase in the exudate; later, contamination with organisms from the GI tract may occur. If the diagnosis seems certain and trauma was not a factor, laparotomy usually is avoided and reserved for the complications of pancreatic necrosis, abscess, or pseudocyst. However, failure to improve may be an indication for earlier operation.

"Pancreatic exudate containing toxins and activated pancreatic enzymes permeates the retroperitoneum and at times the peritoneal cavity, inducing a chemical burn and increasing the permeability of blood vessels. This causes extravasation of large amounts of protein-rich fluid from the systemic circulation into "third spaces," producing hypovolemia and shock. On entering the systemic circulation, these activated enzymes and toxins increase capillary permeability throughout the body and may reduce peripheral vascular tone, thereby intensifying hypotension. Circulating activated enzymes may damage tissue directly (eg, phospholipase A2 is thought to injure alveolar membranes of the lungs).

"Pancreatic infection of devitalized retroperitoneal tissue is usually caused by gram-negative organisms. Infection should be suspected if the patient maintains a generally toxic appearance with elevated temperature and WBC count or if deterioration follows an initial period of stabilization. The diagnosis is supported by positive blood cultures and particularly by the presence of air bubbles in the retroperitoneum on abdominal CT. Percutaneous aspiration of pancreatic exudate guided by abdominal CT may reveal organisms on Gram stain or culture, which should lead to prompt surgical debridement. Mortality rate is usually 100% without extensive surgical debridement of infected retroperitoneal tissue.

"Pancreatitis associated with necrosis and hemorrhage has a mortality rate > 10 to 50%. This diagnosis is suggested by a progressive decrease in Hct, presence of hemorrhagic fluid within ascites, reduction in serum Ca, and Grey Turner's or Cullen's sign (indicating extravasation of hemorrhagic exudate to the flanks or umbilical region, respectively).

"Acute pancreatitis is complicated by para-ascitic pleural effusion in about 10% of cases. The pleural exudate is rich in neutrophils, containing much more amylase than the serum does. The effusions are usually small; about 60% are left-sided, 30% right-sided, and 10% bilateral.

"Pancreatic pseudocysts may burrow into the mediastinum through the aortic or esophageal hiatus and rupture into one or both pleural spaces. Amylase levels in the pleural fluid are very high (up to 100,000 IU/L), even though serum amylase may be normal. Abdominal ultrasound and CT scans help diagnose pancreatic pseudocyst. Because fluid reaccumulates rapidly after thoracentesis, the pseudocyst must be drained.

"Ascites may be associated with pleural effusion because fluid can move from the peritoneal space into the pleural space through diaphragmatic defects or lymphatic channels; 70% of para-ascitic effusions are right-sided, 15% left-sided, and 15% bilateral. They occur in about 5% of patients with cirrhosis and ascites. Meigs' syndrome (pleural effusion and ascites associated with ovarian fibromas and other ovarian tumors) has a similar mechanism, but the pleural fluid associated with ovarian tumors is generally an exudate. The mechanism is also similar for pleural effusion associated with peritoneal dialysis or acute pancreatitis. Other examples: Metastatic neoplasms are the most common cause of exudates in persons > 60 yr."