Single-carbon chemistry of acetogenic and methanogenic bacteria

Author(s): J.G. Zeikus , R. Kerby and J.A. Krzycki
Source: Science. 227 (Mar. 8, 1985): p1167.
Document Type: Article

COPYRIGHT 1985 American Association for the Advancement of Science
http://www.sciencemag.org/

Single-Carbon Chemistry of Acetogenic and Methanogenic Bacteria

There has been considerable chemical research on the technological application of single-carbon (C1) transformations. Synthesis gas (syngas), a mixture of hydrogen and carbon monoxide has long been used as a feedstock for production of industrial chemicals. Although syngas has been derived from methane it is increasingly manufactured from coal and may be derived from nonfossilized forms of biomass. The role of syngas and C1 chemistry in the production of polymeric chemicals and fuels may increase as the supply of petroleum-derived chemicals becomes limiting (1).

The conversion of single-carbon compounds to higher molecular weight products depends on metal-containing catalysts (2). The conversion of syngas to methane and higher hydrocarbons (Fischer-Tropsch reaction) and of methane to ethanol occur in the presence of iron-, cobalt-, or nickel-containing catalysts. The conversion of methanol (itself derived from syngas by copper-zinc chromite-containing catalysts) and CO to acetic acid depends on homogeneous rhodium-containing catalysts (Monsanto process), although cobalt was used initially and efforts to produce suitable nickel-containing catalysts are under way.

Treatment of traumatic myositis ossificans with acetic acid iontophoresis

Traumatic myositis ossificans is a reactive osseous lesion occurring in soft tissues and at times close to bone and periosteum. [1] It is a result of muscle injury and often reinjury. [1] The hemorrhagic area is organized by granulation and fibrous tissue with fibroblastic cells from the endomysium, which form broad sheets of immature fibroblasts. [1] Primitive mesenchymal cells proliferate within the injured connective tissue and give rise to osteoid and chondroid formation at the periphery progressing inward. [1] Eventually chondrogenesis occurs, and mature lamellar bone is formed. Calcification usually appears in 2 to 3 weeks. The ossification of heterotopic bone occurs within 4 to 8 weeks. [1] Full maturity is reached by 5 to 6 months, at which time the mass may show some decrease in size or resolution. The most common sites of incidence are the anterior high (quadricepts femoris muscle) and the anterior arm (brachialis muscle). [2] Little recent literature exists regarding treatment for myositis ossificans. Traditionally, treatment for myositis ossificans has revovled primarily around controlling hemorrhage. Rest, ice, elevation, compression dressings, and immobilization are initiated with moderate to severe contusions. In addition, an anti-inflammatory agent may be prescribed. [3] Heat, continuous ultrasound, massage, stretching, and exercise shouldbe avoided initially so as not to induce further bleeding in the area. [3] Immobilization is usually continued until all pain has disappeared, at which time range-of-motion maneuvers and strenthening exercises are slowly initiated. [3] Alternative treatments include surgery; aspiration of the hematoma with subsequent injection of 1% lidocaine hydrochloride, anti-inflammatory steroids, and lysosomal enzymes; cold laser therapy; radiation treatments; and acetic acid iontophoresis. [4,5] The literature has shown that traumatic myositis ossificans may take up to 2 years to resolve. Surgical removal of the ossified mass is often a debilitating option. Physicial therapy protocols for this pathology have been argued in the literature. [3-5] Because traumatic myositis ossificans is an uncommon pathology, little research has been completed in this area of treatment. Treatment of this condition with acetic acid iontophoressis may result in a quicker, safer return to activity and may eliminate the need for surgical removal. Iontophoresis is the introduction of topically applied, physiologically active ions through the epidermis using continuous direct current. Described initially by Le Duc in 1908, iontophoresis is based on the principle that an electrical charge will repel a similarly charged ion. [6] The clinical use of acetic acid iontophoresis in the treatment of patients with calcium deposits was first described in 1955 by Psaki and Carroll [7], and again in 1977 by Kahn. [8] The acetate ion found in acetic acid is negative in polarity and has been cited as effective in reducing the size of calcium deposits through the absorption of calcium. [7] Prior to complete ossification, myositis ossificans usually consists of precipitates of calcium carbonate that are not soluble in normal blood pH levels. [8] It has been postulated that the acetate radical replaces the carbonate radical in the insoluble calcium carbonate deposit, forming a more soluble calcium acetate, as the following equation demonstrates [9]: [CaCO.sub.2] + [2H(C.sub.2H.sub.3O.sub.2]) =Ca([C.sub.2H.sub.3O.sub.2.).sup.2] + [H.sub.2.O+CO.sub.2] Iontophoresis would appear to be an alternative treatment to injection for introduction of the acetic acid. Because recurrent injury resulting in additional bleeding often is a precursor to the myositis ossificans formation, [10] additional damage to tissues and resultant bleeding may occur from invasive injection by a syringe and needle. Case Report A 16-year-old male soccer player was referred to my clinic by his physician for treatment of his "deep quadriceps contusion." The patient history revealed a diving accident 3 weeks prior to referral in which he dove from a diving board onto a swimmer below. A small contusion developed on his anterior superior iliac spine; however, he continued to swim and dive for the rest of the afternoon. One week later, the patient noticed increased swelling and pain in his right lateral anterior thigh. This pain became progressively worse until the patient was unable to play soccer. During the second week postinjury, pain was increasingly present on descending stairs. The patient was able to ambulate with full weight bearing without pain, although running produced sharp pain in the lateral thigh. He could remember no other traumatic incident since the diving accident. There was no history of prior injury or illness. The patient did not recall any joint pains or muscle aches and had no complaints of sickness or fatigue. He also could not recall having taken any prescribed medications, including aspirin, since the diving accident. Examination by the physical therapist revealed that the patient had pain that restricted passive knee flexion greater than 80 degrees. The patient was able to achieve full hip ROM of 120 degrees. He had pain with isometric knee extension, but no pain with resisted hip flexion. He was able to achieve full passive knee extension, but was unable to perform an isometric quadriceps femoris muscle contraction in full extension. The patient experienced pain upon palpation of the vastus lateralis musculature, and a well-circumscribed firm mass approximately 10X6 cm was noted. the mass was fixed, nonpulsatile, and not warm. No signs of redness or streaking around the mass were found, and the patient had a normal body temperature. The patient was then referred back to his physician with a suggestion that the physician investigate the possibility of myositis ossificans. The physician ordered anterior-posterior and lateral radiographs of the right femur, which revealed a maturing myositis ossificans located in the region of the vastus lateralis musculature (Fig. 1). Radiographic measurements revealed the mass to be 7.1 cm in length, 4.2 cm in width, and 2.1 cm in thickness. The physician hypothesized that the small anterior superior iliac spine contusion may have bled into the lateral thigh musculature, therefore contributing to the formation of the myositis ossificans. The therapist discussed treatment options for myositis ossificans with the physician. In an attempt to decrease the size and possible progression of the calcium formation, acetic acid iontophoresis was chosen to supplement the physician's prescription of rest and inactivity. The patient was treated with acetic acid iontophoresis in accordance with Sharp's protocol [11] for 3 weeks. Both electrode sites were thoroughly cleansed with an isopropyl alcohol wipe, and the active (negative) drug electrode was placed over the site of ossification. Three milliliters of a 2% acetic acid solution using a distilled water dilution medium was introduced into the active drug electrode. The drug electrode (IOMED model EL501*) consisted of a closed polyurethane reservoir with a semipermeable membrane and an adhesive border for fixation. The treatment area of the electrode was approximately 2.5 cm in diameter. A 4.2-cm [2] karaya pad was used as the dispersive electrode and was placed 8 cm distal to the active electrode. Using an iontophoresis unit (IOMED model PM600 Phoresor Iontophoretic Drug Delivery System*), the patient was treated with 4 mA of direct current for 20 minutes, for a total of 80 mA.min, in accordance with Sharp's protocol. [11] This treatment was followed by 9 minutes of 1.5 W/cm [2] of pulsed ultrasound at a 50% duty cycle. An ultrasonic coupling gel was used as the transfer medium. Ultrasound was administered directly over the myositis ossificans site in an attempt to decrease skin irritation and to possibly further disperse the acetic acid throughout the injury site. Additional treatment consisted of mild treatment consisted of mild passive-range-of-motion (PROM) movements within pain-free limits for 5 minutes three times a week. The patient was instructed to avoid any painful activity including stair climbing. He was instructed not to participate in any sports during the 3-week treatment period. The iontophoresis, ultrasound, and passive stretching treatment was administered on alternate days three times per week for 3 weeks. After the fifth treatment, the mass became increasingly compressible, and the patient's pain-free ROM improved to 110 degrees of knee flexion. At the conclusion of nine treatments, radiographs revealed the mass to be 2.8 cm in length, 0.3 cm in width, and 0.8 cm in thickness (Fig. 2). These results represent a 98.9% decrease in the size of the mass. The patient regained full knee ROM of 149 degrees and was able to resume playing soccer pain-free. He had no pain with any activities of daily living including running and descending stairs. A protective Orthoplast (+) "donut" thigh pad was then placed over the area of previous injury in an attempt to protect against future injury to the thigh musculature during athletic activity. What caused the reabsorption of the calcifying myositis ossificans in this patient is unknown. Ultrasound may have enhanced the resorption of the soluble calcium acetate. It is also questionable whether the ultrasound treatment itself played a role in the resolution of the mass. It has been inconclusively argued in the literature as to whether bone reabsorption or formation is enhanced by ultrasound. [12,13] Properly controlled studies are necessary to determine the efficacy of the individual entities of the treatment program chosen. Myositis ossificans seems to be a self-limiting disease. There is a spontaneous resolution after maturation in many cases, [14] but reports have shown that traumatic myositis ossificans may take up to 2 years to resolve. Only a small percentage seem to need surgical excision; however, this is often a debilitating option. Possible clinical implications for acetic acid iontophoresis may include myositis ossificans, calcific joint deposits, frozen shoulder, and heel spur formation. Summary and Conclusions As traumatic myositis ossificans is an uncommon pathology, little research has been completed in this area of treatment. This case report describes the treatment of a 16-year-old boy with a diagnosis of postraumatic myositis ossificans. The patient's 3-week physical therapy program consisted of a 2% acetic acid iontophoresis treatment followed by pulsed ultrasound and mild PROM movements. Following completion of the program, a 98.9% reduction in the size of the calcifying mass was demonstrated by radiographic evidence. Further studies are needed to support the use of acetic acid iontophoresis for both treatment and possible use as prevention once initial trauma has occurred. Controlled studies with acetic acid iontophoresis and myositis ossificans are necessary to establish a cause-effect relationship. Additional research, including single-subject designs, should be implemented to document the efficacy of this procedure. References [1] Tyler JL, Derbekyan V, Lisbona R. Early diagnosis of myositis ossificans with To99m diphosphonate imaging. Clin Nucl Med. 1984;9:460-462. 1984;9:460--462. [2] Huss CD. Myositis ossificans of the upper arm. Am J Sports Med. 1980;8:419--424. [3] Nalley J, Susan Jay M, Durant RH. Myositis osiificans in an adolescent following a sports injury. J Adolesc Health Care. 1985;6:460--462. [4] Ellis M, Frank HG. Myositis ossificans traumatica: with special reference to the quadriceps femoris muscle. J Trauma. 1966;6:724--738. [5] Jackson DW, Feagin JA. Quadriceps contusions in young athletes. J Bone Joint Surg [Am]. 1973;55:95--104. [6] Cummings J. Iontophoresis. In: Nelson RM, Currier DP, eds. Clinical Electrotherapy. East Norwalk, Conn: Appleton & Lange; 1987:231. [7] Psaki CG, Carroll J. Acetic acid ionization: a study to determine the absorptive effects upon calcified tendinitis of the should. Phys Ther Rev. 1955;35:84--87. [8] Kahn J. Acetic acid iontophoresis for calcium deposits: suggestion from the field. Phys Ther. 1977;57:658--659. [9] Kahn J. Principles and Practice of Electrotherapy. New York, NY: Churchill Livingstone Inc; 1987;165. [10] Antao NA. Myositis of the hip in a professional soccer player. Am J Sports Med. 1988;16:82--83. [11] Sharp N. Acetic: a solution for some frozen shoulders. Phoresor Forum. 1988;7(5):1. [12] Cline PD. Radiographic follow-up of ultrasound therapy in calcific bursitis: case report. Phys. Ther. 1963;43:659--660. [13] Ziskin MC, Michlovitz SL. Therapeutic ultrasound. In: Michlovitz SL, ed. Thermal Agents in Rehabilitation. Philadelphia, Pa: FA Davis Co; 1986:160. [14] Thorndike A. Myositis ossificans traumatica. J. Bone Joint Surg [Am]. 1940;22:315--323. Source Citation (MLA 7th Edition) Wieder, Deborah L. "Treatment of traumatic myositis ossificans with acetic acid iontophoresis." Physical Therapy Feb. 1992: 133+. Academic OneFile. Web. 12 June 2013.