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C H Tator

Publications and source records attributed to C H Tator.

At least 37 records · Page 2Linked to original sources
PubMed2000

Effect of brain-derived neurotrophic factor, nerve growth factor, and neurotrophin-3 on functional recovery and regeneration after spinal cord injury in adult rats.

This study examined whether continuous intramedullary infusion of brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), or neurotrophin-3 (NT-3) had either an early neuroprotective effect or a delayed effect on regeneration after spinal cord injury (SCI) in adult rats. BDNF, NGF, NT-3 or vehicle was infused at a rate of 625 ng/h into the SCI site at T3 through an implanted cannula attached to an osmotic pump. This infusion was maintained for 14 days after a 35-g clip compression injury. At 4 weeks after injury, the axonal tracer fluorogold (FG) was introduced into the spinal cord caudal to the lesion and the animals sacrificed 3 days later following behavioral assessment. The inclined plane score was significantly higher in BDNF-treated animals (45 +/- 3 degrees) compared to control animals (36 -/+ 1 degrees) at 1 week after injury (p < 0.05), although the scores were not significantly different at later times. BDNF-treated animals also showed more FG-labeled cells in the red nucleus and sensorimotor cortex (1,638 +/- 350 and 124 +/- 83, respectively) compared to controls (1,228 +/- 217 and 36 +/- 15, respectively) and a lower percent cavitation at the injury site (21.4 +/- 10.4%) compared to control animals (32.3 +/- 11.7%). Invasion & proliferation of Schwann cells and formation of peripheral myelin were more prominent at the injury site in the BDNF-treated animals than in the other groups. These results indicate that continuous intramedullary infusion of BDNF provides neuroprotection and enhances some regenerative activity after SCI.

Animals↗
PubMed2000

Epidermal growth factor and fibroblast growth factor 2 cause proliferation of ependymal precursor cells in the adult rat spinal cord in vivo.

We investigated the mitogenic effect of continuous intrathecal infusion of epidermal growth factor (EGF) or fibroblast growth factor 2 (FGF2) on ependymal precursor cells of the adult rat spinal cord in vivo. Either EGF, FGF2, EGF plus FGF2, or artificial cerebrospinal fluid (aCSF) was infused at a flow rate of 0.5 microl/h (15 ng/h of EGF or FGF2) for 3 or 14 days into the intrathecal space at T1 through a catheter attached to an osmotic minipump. To assess proliferation, the bromodeoxyuridine (BrdU) labeling index (LI) in the ependyma at T1 was calculated at 3 or 14 days. At 3 days there was no statistical difference in LI between these groups, but at 14 days the LI was significantly higher in the EGF plus FGF2 group (27.2% = 16.0%) than in the aCSF group (5.4% +/- 4.7%; p < 0.05). With EGF alone or FGF2 alone, the LI increases were not significantly different from the aCSF group. With EGF plus FGF2 for 14 days, some BrdU-positive cells in the ependyma also expressed nestin. These results suggest that the intrathecal infusion of EGF plus FGF2 has a mitogenic effect on precursor cells in the ependyma of the adult rat spinal cord.

Animals↗
PubMed2000

Prevention of spinal cord injuries caused by diving: evaluation of the distribution and usage of a diving safety video in high schools.

OBJECTIVE: To determine and assess the distribution and use of Sudden Impact, a video designed by Think First and SportsSmart Canada, to help prevent spinal cord injury caused by careless shallow water diving among teenagers in the high risk group (15-24 years old). DESIGN: Survey of 92 public secondary schools in Toronto, Canada. SUBJECTS: The heads of the physical and health education departments of the 92 secondary public schools in the Metropolitan Toronto region. RESULTS: The response rate was 64% (59 schools), of which 76% (45) had actually received the video. Forty one schools (91%) of those that received the video reported using it. Eighty per cent of responding schools showed it to grade 11 students. Eighty per cent of schools with swimming pools used the video compared with only 42% of schools without swimming pools. CONCLUSIONS: There is a need for improvements in the system of distribution to ensure greater use of material such as this video. These may include direct distribution to principals, continuing contact with the schools, or mandatory inclusion of diving safety into the school curriculum.

Adolescent↗
PubMed2000

The natural history of untreated vestibular schwannomas. Is there a role for conservative management?

OBJECTIVE: The aim of this study was to investigate the natural history and outcome following the conservative management of a group of patients with unilateral vestibular schwannomas. METHODS: 72 patients with a radiological diagnosis of unilateral vestibular schwannoma were managed conservatively because of poor general health, advanced age, patient preference, small tumour size, minimal symptoms, or tumour in the only/better hearing ear. All patients underwent serial magnetic resonance imaging for assessment of tumour growth, according to American Academy of Otolaryngology-Head & Neck Surgery guidelines (1995). The mean duration of follow-up was 37.8 months (range 12-194 months). Patients were deemed to have failed conservative management if there was evidence of continuous or rapid radiological tumour growth, and/or increasing symptoms or signs. RESULTS: The mean tumour growth rate was 1.16 mm/year (range -0.75 to 9.65 mm/year). Approximately 83% of tumours grew at less than 2 mm/year. Significant tumour growth (total growth > 1 mm) was seen in 36.4%, no or insignificant growth (0-1 mm) in 50%, and negative growth (< 0 mm) in 13.6% of tumours. The growth rate of cerebellopontine angle (CPA) tumours (1.4 mm/year) was significantly greater than that of tumours limited to the internal auditory canal (IAC) (0.2 mm/year) (p = 0.001). Failure of conservative management, in which active treatment was required, occurred in 15.3%. The outcome of these patients appeared to be as favourable as those who underwent primary treatment, without a period of conservative management. The growth rate of tumours in patients who failed conservative management (4.2 mm/year) was significantly greater than that in patients who did not fail (0.5 mm/year) (p < 0.01). No factors predictive of tumour growth were identified. Deterioration of mean pure tone average (0.5, 1, 2, 3 kHz) and speech discrimination scores occurred regardless of whether radiological tumour growth was demonstrated or not. CONCLUSIONS: The majority of vestibular schwannomas are slow growing, although, CPA tumours appear to grow faster than IAC tumours. Deterioration of auditory function occurs even in the absence of tumour growth. Although most Otolaryngologists and Neurosurgeons would agree that the treatment of choice for the majority of vestibular schwannomas is microsurgery, there remains a small group of patients in whom a conservative management approach may be a desirable alternative.

Adult↗
PubMed1999

The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part II: Results of a multicenter study.

STUDY DESIGN: A multicenter, retrospective study using computed tomographic and magnetic resonance imaging data to establish quantitative, reliable criteria of canal compromise and cord compression in patients with cervical spinal cord injury. OBJECTIVES: To develop and validate a radiologic assessment tool of spinal canal compromise and cord compression in cervical spinal cord injury for use in clinical trials. SUMMARY OF BACKGROUND DATA: There are few quantitative, reliable criteria for radiologic measurement of cervical spinal canal compromise or cord compression after acute spinal cord injury. METHODS: The study included 71 patients (55 men, 16 women; mean age, 39.7 +/- 18.7 years) with acute cervical spinal cord injury. Causes of spinal cord injury included motor vehicle accidents (n = 36), falls (n = 20), water-related injuries (n = 8), sports (n = 5), assault (n = 1), and farm accidents (n = 1). Canal compromise was measured on computed tomographic scan and T1- and T2-weighted magnetic resonance imaging, and cord compression at the level of maximum injury was measured on T1- and T2-weighted magnetic resonance imaging. All films were assessed by two independent observers. RESULTS: There was a strong correlation of canal compromise and/or cord compression measurements between axial and midsagittal computed tomography, and between axial and midsagittal T2-weighted magnetic resonance imaging. Spinal canal compromise assessed by computed tomography showed a significant although moderate correlation with spinal cord compression assessed by T1- and T2-weighted magnetic resonance imaging. Virtually all patients with canal compromise of 25% or more on computed tomographic scan had evidence of some degree of cord compression on magnetic resonance imaging, but a large number of patients with less than 25% canal compromise on computed tomographic scan also had evidence on magnetic resonance imaging of cord compression. CONCLUSIONS: In patients with cervical spinal cord injury, the midsagittal T1- and T2-weighted magnetic resonance imaging provides an objective, quantifiable, and reliable assessment of spinal cord compression that cannot be adequately assessed by computed tomography alone.

Adolescent↗
PubMed1999

Spinal cord-evoked potentials and muscle responses evoked by transcranial magnetic stimulation in 10 awake human subjects.

Transcranial magnetic stimulation (TCMS) causes leg muscle contractions, but the neural structures in the brain that are activated by TCMS and their relationship to these leg muscle responses are not clearly understood. To elucidate this, we concomitantly recorded leg muscle responses and thoracic spinal cord-evoked potentials (SCEPs) after TCMS for the first time in 10 awake, neurologically intact human subjects. In this report we provide evidence of direct and indirect activation of corticospinal neurons after TCMS. In three subjects, SCEP threshold (T) stimulus intensities recruited both the D wave (direct activation of corticospinal neurons) and the first I wave (I1, indirect activation of corticospinal neurons). In one subject, the D, I1, and I2 waves were recruited simultaneously, and in another subject, the I1 and I2 waves were recruited simultaneously. In the remaining five subjects, only the I1 wave was recruited first. More waves were recruited as the stimulus intensity increased. The presence of D and I waves in all subjects at low stimulus intensities verified that TCMS directly and indirectly activated corticospinal neurons supplying the lower extremities. Leg muscle responses were usually contingent on the SCEP containing at least four waves (D, I1, I2, and I3).

Adult↗
PubMed1999

Surgical treatment for acute spinal cord injury study pilot study #2: evaluation of protocol for decompressive surgery within 8 hours of injury.

Acute spinal cord injury (SCI) is a major public health problem for which there is still only limited treatment available. The National Acute Spinal Cord Injury Study-2 (NASCIS-2) and -3 clinical trials demonstrated that the use of acute pharmacotherapy with methylprednisolone can attenuate the secondary injury cascade if administered within 8 hours of acute SCI. However, no trial has been performed to examine whether acute surgical decompressive procedures within this critical 8-hour time window can improve patients' neurological outcome. The purpose of the current prospective Surgical Treatment for Acute Spinal Cord Injury Study (STASCIS) pilot study was to determine the feasibility of obtaining a radiological diagnosis of spinal canal compromise of 25% or more and to perform spinal cord (C3-T1) decompressive procedures by 8 hours postinjury. One of the following three decompressive methods was used: 1) traction alone; 2) traction and surgery; or 3) surgery alone. Twenty-six patients from eight North American centers were entered into the study between 1996 and 1997. Significant difficulties were encountered in many centers in performing immediate magnetic resonance imaging examination in patients with acute SCI. Fewer than 10% of acute cervical SCI patients could be enrolled into this protocol mainly because the combination of the required time for rescue, resuscitation, transport, imaging study, and surgical preparation exceeded the 8-hour injury-to-decompressive surgery window. Eleven patients underwent decompressive procedures initially by being placed in traction at a mean time of 10.9 hours postinjury. Those patients not undergoing this procedure underwent decompressive surgery at a mean time of 40.1 hours. However, the surgical decompressive procedure was completed within 12 hours in seven patients. As a result of these findings, several major changes have been made to the STASCIS protocol for early decompressive therapy.

Journal Article↗
PubMed1999

Review of clinical trials of neuroprotection in acute spinal cord injury.

In this paper the authors review the clinical trials of neuroprotection that have been performed for the treatment of acute spinal cord injury (SCI). The biological rationale for the selection of each treatment modality is discussed with reference to current knowledge of the principles in the management of acute SCI as well as the primary and secondary injury mechanisms identified by experimental and clinical studies of the pathophysiology of acute SCI. The trials are evaluated with regard to the availability and use of accurate clinical outcome measures, and the methodologies of the trials are critically evaluated with an emphasis on prospective randomized controlled studies. A detailed description and critical analysis are provided of the results of the 10 clinical trials conducted to date in which a randomized prospective controlled design has been used. The issue of the therapeutic time window in acute SCI is discussed. To date, methylprednisolone is the only effective neuroprotective agent that has been established for use in human SCI, and the only therapeutic time window established in human SCI is a maximum trauma-to-treatment time of 8 hours.

Journal Article↗
PubMed1999

Syringomyelic dystonia and athetosis.

Two patients with movement disorders associated with syringomyelia are described, one of whom developed unusual torticollis, and the other had choreoathetoid-dystonic movements of the hand and arm. In each case, the movements resolved with decompression of the syrinx. The literature is reviewed and possible mechanisms explored.

Adult↗
PubMed1999

Effects of MK801 on evoked potentials, spinal cord blood flow and cord edema in acute spinal cord injury in rats.

OBJECTIVES: To determine whether MK801, an NMDA receptor antagonist, blocks glutamate excitotoxicity directly or via other mechanisms such as improving blood supply at the injury site in a rat model of spinal cord injury (SCI). In the present study, the effects of pre- and posttreatment with MK801 on axonal function, spinal cord blood flow (SCBF) and cord water content were studied after acute SCI in rats. METHODS: Somatosensory evoked potentials (SSEPs) and cerebellar evoked potentials (CEPs) were used to quantify electrophysiological function, and the hydrogen clearance technique and wet-dry weight measurements were used to measure SCBF and cord water content, respectively. Twenty rats received a 21 g clip compression injury of the cord at T1, and were then randomly and blindly allocated to either MK801 or saline groups. Each rat received an intravenous infusion of drug or saline four times during the experiment (16 min/infusion) with the first infusion (MK801 3 mg/kg) beginning 8 min pre-injury, and the other infusions (MK801 1. 5 mg/kg) at 1 h intervals after injury. Control experiments on uninjured rats were performed in 10 rats using the same procedure as above except the clip compression injury of the cord was omitted. RESULTS: In the MK801 groups with or without SCI, the amplitude of the evoked potential peaks, especially the SSEPs, was significantly lower than in the saline group. There were no differences in SCBF or cord water content between the MK801 and saline groups. CONCLUSION: Pre- and posttreatment with MK801 inhibits evoked potentials, but does not improve SCBF or cord edema after acute compression SCI in rats. For the first time it has been shown that MK801 produced a blockade of glutamate excitatory transmission in afferent pathways after SCI. Further work is required to determine whether this inhibition is reversible and related to neuroprotection and functional recovery after SCI.

Acute Disease↗
PubMed1999

Autoradiographic [3H]nimodipine distribution after experimental spinal cord injury in rats.

Because of its potential for augmentation of blood flow and protection of neurons after neurological insult, nimodipine has been investigated as a treatment of spinal cord injury (SCI). The results have been inconsistent, possibly because of poor delivery of nimodipine to the injured spinal cord. The following study was designed to determine the delivery of nimodipine to the injured spinal cord. It was also hoped that information about the temporal and spatial pattern of binding of nimodipine after SCI might further elucidate the relationship between calcium channel activation and injury. Fourteen female Wistar rats were divided into three groups: control (n = 3), 30 min post-SCI (n = 6); and 4 h post-SCI (n = 5). The injury was produced by acute clip compression for 1 min at T1. [3H]Nimodipine was administered 5 min after laminectomy in the control group, and at the above-specified times after injury in the SCI groups. The drug was then allowed to equilibrate for 30 min before the animals were killed. The spatial patterns and concentrations of [3H]nimodipine in various segments of the spinal cord were autoradiographically determined. The highest concentrations of [3H]nimodipine were at the injury site after SCI. Also, the mean [3H]nimodipine concentrations in all sites in each animal were higher in the injury groups than in the control group (p < 0.05). This study indicates that delivery of this agent to the injured cord is possible, and provides evidence of widespread Ca2+ channel activation in the first 4 h after injury.

Animals↗
PubMed1999

Cell proliferation and nestin expression in the ependyma of the adult rat spinal cord after injury.

A population of precursor cells is known to exist in the subependyma of the lateral ventricles in adult rodents. However, the source of the precursor cells in the adult mammalian spinal cord has not been identified in vivo, although the adult spinal cord was recently reported to contain neural stem cells in vitro. In this study we found active cell proliferation and nestin expression in the adult ependyma of the central canal after spinal cord injury. The normal ependyma showed limited proliferative activity indicated by a low Ki-67 labeling index (1.5% at T1 level) and no immunoreactivity to nestin, a marker for neural precursor cells. In contrast, the spinal cord injured by clip compression demonstrated a dramatic increase in ependymal proliferation indicated by a high Ki-67 labeling index (maximum of 26% at 3 days [d] after injury) and concomitant strong nestin expression in the ependyma. These responses were downregulated by 7 d after injury. The increased cell proliferation in the ependyma was observed only at sites immediately adjacent to the lesion. After injury, nestin positive, GFAP negative cell populations were found in areas surrounding the ependymal layer, which suggests migration of the ependymal cells. These results indicate the precursor cell qualities of the adult ependyma after injury. Thus, we propose the ependyma of the central canal, which is normally latent but activates locally and temporally in response to spinal cord injury, as the in vivo source for precursor cells in the adult mammalian spinal cord.

Animals↗
PubMed1999

An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies.

OBJECT: The authors conducted an evidence-based review of the literature to evaluate critically the rationale and indications for and the timing of decompressive surgery for the treatment of acute, nonpenetrating spinal cord injury (SCI). METHODS: The experimental and clinical literature concerning the role of, and the biological rationale for, surgical decompression for acute SCI was reviewed. Clinical studies of nonoperative management of SCI were also examined for comparative purposes. Evidence from clinical trials was categorized as Class I (well-conducted randomized prospective trials), Class II (well-designed comparative clinical studies), or Class II (retrospective studies). Examination of studies in which animal models of SCI were used consistently demonstrated a beneficial effect of early decompressive surgery, although it is difficult to apply these data directly to the clinical setting. The clinical studies provided suggestive (Class III and limited Class II) evidence that decompressive procedures improve neurological recovery after SCI. However, no clear consensus can be inferred from the literature as to the optimum timing for decompressive surgery. Many authors have advocated delayed treatment to avoid medical complications, although good evidence from recent Class II trials indicates that early decompressive surgery can be performed safely without causing added morbidity or mortality. CONCLUSIONS: There is biological evidence from experimental studies in animals that early decompressive surgery may improve neurological recovery after SCI, although the relevant interventional timing in humans remains unclear. To date, the role of surgical decompression in patients with SCI is only supported by Class III and limited Class II evidence. Accordingly, decompressive surgery for SCI can only be considered a practice option. Furthermore, analysis of the literature does not allow definite conclusions to be drawn regarding appropriate timing of intervention. Hence, there is a need to conduct well-designed experimental and clinical studies of the timing and neurological results of decompressive surgery for the treatment of acute SCI.

Acute Disease↗
PubMed1999

Current use and timing of spinal surgery for management of acute spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study.

OBJECT: A multicenter retrospective study was performed in 36 North American centers to examine the use and timing of surgery in patients who have sustained acute spinal cord injury (SCI). The study was performed to obtain information required for the planning of a randomized controlled trial in which early and late decompressive surgery are compared. METHODS: The records of all patients aged 16 to 75 years with acute SCI admitted to 36 centers within 24 hours of injury over a 9-month period in 1994 and 1995 were examined to obtain data on admission variables, methods of diagnosis, use of traction, and surgical variables including type and timing of surgery. A total of 585 patients with acute SCI or cauda equina injury were admitted to participating centers, although approximately half were ultimately excluded because they did not meet inclusion criteria. Common causes for exclusion were late admission, age, gunshot wound, and absence of signs of compression on imaging studies. Thus, only approximately 50% of patients with acute SCI would be eligible for inclusion in a study of acute decompressive surgery. Although all patients underwent computerized tomography (CT) scanning, only 54% underwent magnetic resonance imaging, and CT myelography was performed in only 6%. Complete neurological injuries (American Spinal Injury Association Grade A) were present in 57.8%. Traction was applied in only 47% of patients who sustained cervical injury, in whom decompressive traction was successful in only 42% of cases. Neurological deterioration occurred in 8.1% of cases after traction. Surgery was performed in 65.4% of patients. The timing of surgery varied widely: less than 24 hours postinjury in 23.5%, between 25 and 48 hours postinjury in 15.8%, between 48 and 96 hours in 19%, and more than 5 days postinjury in 41.7% of patients. CONCLUSIONS: These data indicate that although surgery is commonly performed in patients with acute SCI, one third of cases are managed nonoperatively, and there is very little agreement on the optimum timing of surgical treatment. The results of this study confirm the need for a randomized controlled trial to assess the optimum timing of decompressive surgery in SCI.

Acute Disease↗
PubMed1998

Spinal injuries in ice hockey.

SportSmart Canada maintains a registry of spinal injuries in hockey and has documented 214 cases of fracture or dislocation of the spine, occurring mainly in North America since 1966. The current annual incidence is approximately 15 cases per year and may be declining as a result of intense prevention programs. Most of the injuries have been to the cervical spine in players 16 to 20 years of age playing supervised games. Checking from behind causing impact of the head against boards has been an important cause of injury, especially for those injuries resulting in neurological deficit.

Adolescent↗
PubMed1998

Stereotactic radiosurgery for acoustic neuroma: a Canadian perspective.

Stereotactically delivered radiation is now an accepted treatment for patients with acoustic neuroma. In some cases, patient preference may be the reason for its selection, while in others neurosurgeons may select it for patients who are elderly or have significant risk factors for conventional surgery. The majority of patients with acoustic neuroma treatment with stereotactic radiosurgery have been treated with the Gamma Knife, with follow ups of over 25 years in some instances. Other radiosurgery modalities utilizing the linear accelerator have been developed and appear promising, but there is no long-term follow up. Canada does not possess a Gamma Knife facility, and its government-funded hospital and medical insurance agencies have made it difficult for patients to obtain reimbursement for Gamma Knife treatments in other countries. We review the literature to date on the various forms of radiation treatment for acoustic neuroma and discuss the current issues facing physicians and patients in Canada who wish to obtain their treatment of choice.

Canada↗