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Biomedical subjects

L G Giles

Publications and source records attributed to L G Giles.

At least 19 recordsLinked to original sources
PubMed2001

An unusual cause of incontinence.

BACKGROUND: Incontinence is the most common urological symptom of tethered cord syndrome and may present as the earliest sign of this condition. The presence of unexplained incontinence with spinal anomalies, low back and leg symptoms, should raise the suspicion of tethered cord syndrome and lead to a lumbar MRI study, even though only subtle neurological abnormalities are found. OBJECTIVE: This case acts as a timely reminder of the need to be familiar with adult tethered cord syndrome so that an appropriate diagnosis is made promptly. DISCUSSION: The two groups of tethered cord syndrome, group 1 and group 2, are briefly defined; this paper discusses the presenting history of a patient in the first group.

Diagnosis, Differential↗
PubMed2000

Mechanisms of neurovascular compression within the spinal and intervertebral canals.

OBJECTIVE: To describe some possible causes of encroachment on human spinal and intervertebral canal (foramen) neurovascular II structures. DATA SELECTION AND SYNTHESIS: A review of some imaging films of patients aged 38 to 52 years and some human autopsy histopathologic sections from 40- to 60-year-old cadavers to determine what structures may be responsible for neurovascular compression in individuals in this relatively young-to-middle-age group and to illustrate some examples. RESULTS: Stenosis of the spinal and intervertebral canal neurovascular structures can be caused by various bony and soft-tissue structures. Stenosis can be related to osteophytosis of the vertebral body, uncoverte-intervertebral disc protrusion, ossification of the posterior longitudinal ligament, and ligamentum flavum hypertrophy or buckling. DISCUSSION: Various forms of spinal and intervertebral canal stenosis can cause compression of neurovascular structures that may, in turn, be responsible for symptomatology. Of course, autopsy findings cannot be equated with painful syndromes in patients.

Adult↗
PubMed1997

Shadows of the truth in patients with spinal pain: a review.

OBJECTIVE: Spinal pain with or without referred pain is a major and costly health problem that can arise from many anatomical structures. Sophisticated diagnostic imaging devices cannot show some of these structures, and frequently imaging provides only a shadow of the truth. This review illustrates how symptoms may well have an organic cause that is not detectable by current methods of examination, including imaging. METHOD: This study reviews some histopathological findings that can be associated with spinal pain with or without referred pain but cannot be seen on imaging. RESULT: Some histopathological changes illustrate imaging device limitations. CONCLUSION: Awareness of the considerable limitations of even sophisticated imaging devices is necessary when managing patients with acute or chronic spinal pain with or without referred pain. Symptoms may well be genuine and not of psychogenic origin: a diagnosis of malingering, therefore, should not be made lightly.

Adult↗
PubMed1994

A histological investigation of human lower lumbar intervertebral canal (foramen) dimensions.

OBJECTIVE: To determine the proximity of neural structures to the boundaries of the interpedicular zone of the intervertebral canal in cadaveric adult human spines at the L4-5 and L5-S1 spinal levels. DESIGN: Nine randomly chosen blocks of human lumbosacral spinal tissues were processed for histological examination and mensuration of their left and right L4-5 and L5-S1 interpedicular zones of the intervertebral canals (foramina). Measurements of the important interpedicular zone were made using a computerized morphometry system to determine (i) the ratio between the cross-sectional area of the interpedicular zone canal and its large neural structure(s), (ii) the proximity of these neural structures to the boundary of the interpedicular zone, and (iii) the horizontal length of the interpedicular zone of the intervertebral canal. RESULTS: The mean cross-sectional area ratio of the interpedicular zone of the intervertebral canal to large neural structure(s) is 22.9 (SD 6.7)-30.8 (SD 4.4)% at the L4-5 level and 24.9 (SD 5.3)-31.1 (SD 5.3)% at L5-S1. The cross-sectional area of the interpedicular zone is 3.3 (SD 0.5)-4.8 (SD 1.7) times (X) larger than that of the large neural structures at the L4-5 level, and 3.3 (SD 0.6)-4.2 (SD 0.8) at the L5-S1 level. The mean minimum distance between the large neural structure(s) and the boundary of the interpedicular zone ranges from 0.4 (SD 0.4)-0.8 (SD 0.9) mm at the L4-5 level and from 0.4 (SD 0.4)-0.6 (SD 0.3) mm at the L5-S1 level. The horizontal length of the interpedicular zone of the intervertebral canal ranges from 8.2-12.2 mm. CONCLUSION: Within the interpedicular zone of the intervertebral canal, the minimum distance between neural structures and the boundary can be as little as 0.4 (SD 0.4) mm. The possible ramifications of this finding are discussed with regard to a previous gross anatomical study performed by Crelin (1973) that emphasized the anatomically and clinically less relevant lateral border of the intervertebral canal.

Aged↗
PubMed1992

The surface lamina of the articular cartilage of human zygapophyseal joints.

Literature referring to the conflicting results of investigations into the possible existence and composition of the lamina splendens is reviewed. Two hundred micrometer thick histological sections from 80 human cadaveric lower lumbar zygapophyseal joint articular cartilages were examined by ordinary light and darkfield microscopy. The findings illustrate what appears to be an acellular surface lamina on the opposing cartilaginous surfaces. No speculation is made regarding the possible physiological significance of the lamina based on this anatomical study.

Aged↗
PubMed1992

Pathoanatomic studies and clinical significance of lumbosacral zygapophyseal (facet) joints.

Low back pain, with or without pain referred to the leg, affects up to 85% of the population at some time during their lives, which places an enormous economic burden upon many world communities and costs the United States in excess of $13 billion per year. The role of the lumbosacral zygapophyseal (facet, interlamina) joints in the low back "facet" syndrome is briefly discussed, including the clinical symptomatology. The main purpose of this article is to provide preliminary morphological findings of histological studies of human cadaveric lower lumbosacral spines, which show some examples of how the zygapophyseal joints may be involved in dysfunction of mechanical origin. Statistical analysis of the frequency of these findings will be published when the histological study currently under way is completed. While it is not possible to correlate morphological changes in cadavers with pain, it appears that the zygapophyseal joints and their associated soft tissues could be a source of low back pain of mechanical origin, with or without referred pain to the leg.

Aged↗
PubMed1991

Review of tethered cord syndrome with a radiological and anatomical study: case report.

The primary tethered cord syndrome has been documented mainly in children and adolescents but also in adults, and patients may present with backache, neuromuscular skeletal changes such as club-foot, scoliosis, muscular atrophy, disturbances of gait, or dysfunction of bladder and rectum, or a combination of these conditions. The cadaveric case presented describes plain film radiographic and anatomical findings of spina bifida occulta at the first and second sacral levels, and an enlarged spinous process of the fifth lumbar vertebra, in a 78 year old male cadaver with a tethered spinal cord terminating at the first sacral level. During life, this man had not undergone surgery for tethered spinal cord.

Adult↗
PubMed1990

Intra-articular synovial folds of thoracolumbar junction zygapophyseal joints.

Transverse histological sections from T10-11, T11-12, T12-L1, and L1-2 zygapophyseal joints were examined in 32 post-mortem spines, using light microscopy, to record the presence of intra-articular synovial fold inclusions. In addition, three mid-joint sections from each joint were photographed using 35 mm colour film. From these slides, linear dimensions of the extent of intra-articular synovial fold projection between the zygapophyseal joints were measured using computer-aided planimetry. Small, fibrous folds were commonly found at the joint margins extending from the ligamentum flavum and the fibrous joint capsule. Larger, fibro-adipose synovial folds, projecting between the articular surfaces, were also noted, particularly at T12-L1 and L1-2.

Adolescent↗
PubMed1990

Influence of zygapophyseal joint orientation on hyaline cartilage at the thoracolumbar junction.

Hyaline articular cartilage from 102 thoracolumbar junction zygapophyseal joints was examined using light microscopy. One section from the upper, middle and lower third of each joint at the T10-11, T11-12, T12-L1 and L1-2 spinal levels was photographed using 35 mm color film. Hyaline articular cartilage cross-sectional area of the superior and inferior articular processes of each joint pair, at each level, was digitized using computer-aided planimetry. Differences in area were compared with joint orientation (symmetry or tropism) and geometry of each joint pair at each spinal level. Variation in hyaline cartilage cross-sectional area between joint pairs could be attributed to: a) geometric differences, b) the presence of a mortice joint, or c) osteoarthritic changes, with or without tropism. These findings were most frequently demonstrated at the transitional levels of T11-12 and T12-L1.

Adolescent↗