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Biomedical subjects

J Broseta

Publications and source records attributed to J Broseta.

At least 19 recordsLinked to original sources
PubMed1994

Management of intractable spasticity of supraspinal origin by chronic cervical intrathecal infusion of baclofen.

Today it is accepted that chronic infusion of baclofen produces significant relaxation and drastic reduction of spasms, amelioration of cramping pain and improvement of sphincter functions in spasticity of spinal cord origin. Based on these results our group had the opportunity of treating 11 cases with refractory spasticity and dystonic symptoms due to central damage caused by head injury in 8 cases and to cerebral palsy in 3 using cervical intrathecal infusion of baclofen. During the trial period with percutaneous intrathecal infusion of a daily bolus of 12.5-75 micrograms of baclofen through a reservoir, improvement of mentation and speech conditions, marked improvement of dystonic and abnormal movements of the upper limbs and trunk and a notable reduction of hypertonia were observed in all cases, which led to a better performance of motor activities in skilled acts and transfer. With these preliminary results in mind, in all cases the previous cervical subarachnoid catheter was attached to a programmable pump that infused a daily total dose varying from 100 to 190 micrograms of baclofen in a continuous or multistep complex mode. After a mean follow-up of 21 months previous results were long-lasting. Neither overdose side effects nor malfunction of the system were observed.

Adolescent↗
PubMed1994

High-cervical spinal cord electrical stimulation in brain low perfusion syndromes: experimental basis and preliminary clinical report.

Previous studies of our group showed that C1-C2 spinal cord stimulation increases carotid and brain blood flow in normal conditions in the goat and dog and it has a beneficial vasomotor effect in a model of vasospasm in the rat. For further clinical application it seemed rational to investigate the possible vascular changes mediated by this technique in experimental brain infarction. To this aim, 45 New Zealand rabbits were used. Brain infarction was produced by bilateral carotid ligation in 15, unilateral microcoagulation of the middle cerebral artery in 15 and by microcoagulation of the vertebral artery at the craniocervical junction in the other 15. One week later, following daily clinical scoring and cortical and posterior fossa blood flow readings by laser Doppler, a period of 120 min of right C1-C2 spinal cord electric stimulation was performed. A mean of 27% increase in previous blood flow recordings was obtained at the right hemisphere and a mean of 32% in the posterior fossa. This procedure was used in 10 patients presenting with various cerebral low perfusion syndromes. Though not constant, an increase in alertness, retention, speech, emotional lability and performance in skilled acts was achieved. No MR changes were observed, though SPECT readings showed an increase in blood flow in the penumbral perilesional area.

Adult↗
PubMed1990

Chronic intrathecal baclofen administration in severe spasticity.

On the basis of previous experimental and clinical studies, 14 patients with severe spasticity due to central or spinal cord damage, resistant to all conservative treatments, were selected after a percutaneous trial period for chronic intrathecal baclofen infusion by programmable pumps. The agent was delivered at C4 in quadriplegic patients or in cases with central spasticity and in the neighbouring areas on the affected segments in paraplegic patients. The daily baclofen dose varied from 25 to 260 micrograms and was infused in a bolus, continuously infused or both combined according to the results during the trial period. After a mean follow-up period of 11 months, constant decrease of rigidity, absence of spasms, improvement of bladder function, cramping pain remission, and moderate improvement in walking capacity and transfer activities were usually observed. Neither complications nor side effects were noted.

Adolescent↗
PubMed1990

Role of vasoactive substances in the segmentary vasomotor response following spinal cord stimulation. An experimental study.

It is presumed today that spinal cord stimulation induces local delivery of vasoactive substances, such as prostacyclins, histamine, substance P, and vasoactive neuropeptides, in the perivascular environment and the vascular wall to mediate the segmental vasodilator response. To investigate this mechanism, 9 dogs were subjected to low thoracic spinal cord stimulation. Venous and arterial blood samples from the paraesthesic area in the lower limbs were obtained before and 120 min after stimulation to measure changes in the plasma concentration of vasoactive intestinal peptide, substance P, and histamine. The results were compared with those obtained from vessels of the upper limbs. Blood flow changes following stimulation were recorded by electromagnetic flowmeters. Local arterial vasoactive intestinal peptide showed a mean increase of 33% after 60 min of stimulation. Changes concerning substance P were inconclusive. Local arterial and venous histamine concentrations increased 26 and 29%, respectively, after 60 min of stimulation.

Animals↗
PubMed1989

Critical approach to intrastriatal medullary adrenal implants via open surgery in parkinsonism. Case report.

Encouraged by the recent reports on the beneficial effects obtained with open transplantation of autologous adrenal medullary grafts into striatal structures in case with resistent Parkinson's disease, our team used this procedure in a 63-year-old man presenting with severe bradykinesia and rigidity resistent to all pharmacological attempts. In this case through a laparotomy the right adrenal gland was removed and stored in oxygenated Collins and bicarbonated Ringer solution mixtures while a F2 transventricular approach to the head of the caudatum was done. With the surgical microscope the medullary part of the adrenal gland was dissected and four pieces of mm3 of tissue selected, implanting them in a bed previously carved in the caudatum. Endocrinologic and hydroelectrolytic problems appeared during the immediate postoperative period. In the following 5 months no clinical benefit nor electroneurophysiological changes were observed.

Adrenal Medulla↗
PubMed1989

Cerebral and carotid haemodynamic changes following cervical spinal cord stimulation. An experimental study.

Since it is accepted that spinal cord stimulation may produce segmentary vasodilation, it is presumable that when applied in the high cervical segments some carotid and cerebral blood flow changes can be expected. Following this assumption, 25 dogs and 25 goats were used. Under routine experimental conditions a C 7 laminectomy was performed in these animals and a bipolar lead introduced and manipulated in the epidural space till the right C 2 segment. Right common and internal carotid arteries of the dogs were isolated and electromagnetics probes placed for continuous monitoring of blood flow changes. Right internal maxillary artery was isolated and its branches ligated for flowmetry of hemispheric blood flow in the goat. 131I antipyrine also studied to control regional cerebral blood flow changes. Arterial pressure and blood gasometry were periodically determined to avoid masking results. Pulse width of 0.1 to 0.2 msec, 80 to 120 cps and amplitude to muscle contraction threshold at low rate were used as electrical parameters. After stimulation common and internal carotid blood flow increased with a mean of 60% and hemispheric blood flow with a mean of 55% according to flowmetry findings. Iodoantipyrine studies showed an average increase of 35%. These changes were not modified by atropine, morphine and naloxone and partially blocked by indomethacin, cimetidine and propanolol.

Afferent Pathways↗
PubMed1989

Use of intrathecal baclofen administered by programmable infusion pumps in resistent spasticity.

On the basis of previous experimental and clinical studies patients with severe spasticity due to spinal cord damage from multiple sclerosis in 8 cases and postraumatic paraplegia in 6 and resistent to all conservative treatments were selected for a trial with morphine and baclofen administered intrathecally through a catheter placed in the spinal subarachnoid space rostral to the affected segments and attached to a subcutaneous reservoir. Whereas morphine single injection did not show any benefit, baclofen bolus injection 30 to 60 micrograms, revealed a marked decrease of spasticity and associated symptoms in 8 cases. After checking the clinical effect during 3 weeks and changes in electroneurophysiological studies and bladder manometry the catheter was attached to a subcutaneous programmable pump able to be refilled percutaneously and administered baclofen continuously or more often following a multistep complex programme in total doses of 90 to 150 micrograms per day. After a mean follow-up of 5 months all cases showed an absence of spasms and pain, a notable improvement for bettering of sphincter functions and a marked muscle relaxation that improves motor capacity, leading to increased ambulation or mobility. Neither complications nor side-effects were observed.

Adult↗
PubMed1989

Spinal cord stimulation in deafferentation pain.

Spinal cord stimulation (SCS) was used in 49 cases to control resistant deafferentation pain resulting from causalgia, phantom limb, plexus and nerve root avulsion, postherpetic neuralgia, reflex sympathetic dystrophy and amputation. In all cases, one or two standard percutaneous leads were introduced into the epidural space and manipulated until the spinal segment at which external stimulation provoked paresthesic sensation in the painful area. Two weeks of external stimulation trial was used to determine the efficiency of the system. Pulse width of 0.1-0.2 ms, a rate of 80-120 cps and amplitude to low paresthesia threshold were programmed as electric parameters. In 36 out of the 49 tested cases showing a positive response to percutaneous SCS, the device was permanently implanted. After a mean follow-up of 5.5 years, 57% of patients had satisfactory pain relief (over 75%). Side effects were limited to dislodgement of the electrode in 1 case and wire extrusion in another, both requiring replacement of the stimulator.

Chronic Disease↗
PubMed1988

Intraventricular transplantation of omentum for treatment of hydrocephalus. An experimental study in dogs.

In 17 mongrel dogs an experimental non-communicating hydrocephalus was developed by intracisternal injection of kaolin solution. In 10 of them a portion of omentum was isolated and after suturing end-to-end and the vascular pedicle to the temporal artery and vein the graft was introduced transcortically into the lateral ventricle. Metrizamide ventriculography, intraventricular basal and pulse pressure amplitude, compliance and resistance to CSF drainage were performed to evaluate related changes after surgery. Brain and omentum specimens were submitted for pathological studies. In summary, intraventricular omentum transplantation reduced intracranial pressure, compliance and resistance in experimental hydrocephalus whereas ventricular size remained unchanged. Pathological studies showed graft survival in most animals.

Animals↗
PubMed1988

Local pathological findings in experimental dorsal root entry zone lesions performed by mechanical section, laser and radiofrequency. A comparative study.

Dorsal root entry zone lesions are nowadays accepted as a first choice of treatment to alleviate certain types of chronic pain though it is still controversial to decide proper procedure for lesioning. Based on this last argument in 15 mongrel dogs different types of lesions using mechanical microsection, radiofrequency and laser were done. Under general anaesthesia a C-3 to C-7 laminectomy was performed in all animals and after open the dura mater the posterior nerve rootlets and posterolateral sulcus were identified using magnification. In 5 dogs, a longitudinal 1 mm deep incision from C-4 to C-6 spinal cord segments coinciding with the sulcus was carried out with a microknife; in other 5, a sequence of thermocoagulations produced by a radiofrequency current lower than 35 mA was done at same places and level with intervals of 2 mm; and in the rest of animals, an alike incision in depth, location and level was realised by carbon dioxide laser. Four days and three months after lesioning 2 and 3 animals of each group were sacrificed and spinal cord specimens submitted for histological and ultrastructural studies. Low-power microscopic examination showed that all lesioning methods were able to produce a reasonable well delimited necrotic area involving the whole dorsal root entry zone structures, slightly more diffuse with the laser. Acute perilesional changes as well as chronic ones were nevertheless more evident in mechanical and radiofrequency lesions, over all regarding oedema, perivascular haemorrhage, intraluminal thrombosis and ischaemic alterations.

Animals↗
PubMed1987

Stereotactic evacuation and local administration in intracerebral haematomas. A comparative study.

Based on current controversies on optimal treatment for spontaneous intracerebral haematomas, chronic experiments to investigate the validity of open surgery, stereotactic evacuation and local urokinase administration in these lesions were performed in 52 dogs. Under general anesthesia diverse volumes of autologous blood were intracerebrally injected to produce the haematoma. A catheter was introduced and chronically implanted in the contralateral ventricle for intracranial pressure monitoring. The animals were divided in two groups of 26 dogs each, according to haematoma location in subcortical or basal ganglia structures. The natural history was studied in both groups. Different types of treatment consisting in surgery, stereotactic evacuation, urokinase injection within the clot and both latter techniques combined were carried out 24 or 72 hours following haematoma production. Clinical status, systemic arterial pressure, intracranial pressure and CT scanning were used for result evaluation. Brain specimens were submitted for pathological examination. Our results indicate that stereotactic evacuation performed during the first 24 hours after haematoma occurrence was the most effective and innocuous procedure for basal ganglia lesions. Local urokinase plus stereotactic aspiration showed a high efficacy in controlling delayed basal ganglia and subcortical blood collections. Other therapeutic approaches behaved almost as the natural history.

Animals↗
PubMed1987

High-frequency cervical spinal cord stimulation in spasticity and motor disorders.

High frequency stimulation of the cervical spinal cord was used in an attempt to moderate motor disorders in 10 patients, 5 spastics, 3 dystonics and 2 with spasmodic torticollis. Through a C4 flavectomy a quadripolar flat electrode was introduced into the epidural space, placing the first terminal at C2. Electrical parameters for stimulation were established at 0.05-0.10 msec pulse width, rate of 200-1,400 Hz and amplitude to paresthesia threshold. Stimulation was delivered 1 hour on and 1 hour off during daytime. Subjective, clinical and/or neurophysiological initial improvement were initially observed in 9 cases, in which the stimulation system was permanently implanted. After a mean follow-up of 41.4 months all patients but one had a clinical and neurophysiological condition almost similar to the prestimulation one. To investigate the effect of the so-called high-frequency stimulation on the nervous system, 9 dogs were implanted following the same surgical technique and stimulated with analogous electrical parameters than in human practice. After follow-up of 8 months the pathological studies of the animals did not show any local or suprasegmental alterations on nervous structures except a local huge dural scarring reaction.

Adult↗
PubMed1987

Dorsal root entry zone lesion versus spinal cord stimulation in the management of pain from brachial plexus avulsion.

In six patients with total or partial brachial plexus avulsion, spinal cord stimulation was tried as pain treatment. Two patients had had amputation of the arm and suffered from phantom limb and stump pain. After a mean follow-up of 14 months two patients were painfree, one had partial relief and required analgesics and in three patients there was no effect. In eleven patients, including the three patients in whom spinal cord stimulation had failed to produce a long-lasting pain relief, dorsal root entry zone (DREZ) lesions were performed. At early follow-ups all these patients reported substantial pain relief, but after a mean follow-up of 17 months the results were less favorable: Three patients were pain-free, three had a marked improvement and five had recurrence of the original pain. Neither of the two methods of treatment produced any serious side-effects or permanent sequelae.

Adult↗
PubMed1986

Spinal cord stimulation in peripheral arterial disease. A cooperative study.

Percutaneous epidural stimulation of the low thoracic spinal cord was carried out in 41 patients with pain from peripheral arterial disease of the lower limbs. Results are reported relating to pain, claudication distance, peripheral blood flow, and trophic lesion changes. Following a trial period of stimulation, 37 patients had stimulators permanently implanted. After a mean poststimulation follow-up period of 25 months, substantial pain relief (75% to 100%) was obtained in 29 cases; claudication distance significantly increased in 15 cases; Doppler ultrasound recordings of lower-limb distal arteries showed a tendency toward normalization of pulse-wave morphology, with increase of amplitude in 12 of the 23 patients studied; a rise in skin temperature was also detected by thermography. Distal arterial blood pressure remained unchanged with stimulation. Ischemic cutaneous trophic lesions of less than 3 sq cm healed, but gangrenous conditions were not benefited. A placebo effect or the natural history of the disease can be excluded as the reason for these improvements. It is concluded that spinal cord stimulation is a valid alternative treatment for moderate peripheral arterial disorders when direct arterial surgery is not possible or has been unsuccessful.

Adult↗
PubMed1985

Influence of spinal cord stimulation on peripheral blood flow.

In 27 vasculopathic and 9 nonvasculopathic patients who underwent spinal cord stimulation to treat pain in lower extremities, Doppler recordings and thermography were used to study peripheral blood flow changes during stimulation. Generally, poststimulation pain relief coincided with a improvement of Doppler recording, a normalization of morphology and increase of pulse wave amplitude, and a rise of skin temperature in the painful area.

Arterial Occlusive Diseases↗
PubMed1984

Sequential morphological and functional changes in kaolin-induced hydrocephalus.

An experimental model of kaolin-induced hydrocephalus in the dog was studied in order to evaluate the progress of ventricular dilatation and the communications between the ventricular system and the subarachnoid space. Skull and spine radiological studies were obtained after metrizamide intraventricular injection, and the baseline ventricular pressure and cerebral pulse pressure amplitude were measured in anesthetized animals. Intracranial compliance and resistance to drainage of cerebrospinal fluid were calculated by means of bolus injection test. Light and scanning electron microscope studies were done at different developmental stages of hydrocephalus. With these experimental parameters, two successive phases were seen: an initial acute hypertensive hydrocephalus (H1) with high resistance, low compliance, severe ependymal damage, and subependymal edema; and a late chronic normotensive hydrocephalus (H2) with little resistance increase, normal compliance, epithelial regeneration, and subependymal gliosis. Both the H1 and H2 stages showed an increase in the cerebral pulse pressure amplitude.

Animals↗