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Biomedical subjects

R H Cohen

Publications and source records attributed to R H Cohen.

13 recordsLinked to original sources
PubMed1998

Value of arthrography after supination trauma of the ankle.

OBJECTIVE: To investigate the merits of arthrography after supination trauma of the ankle. DESIGN AND PATIENTS: In a group of 160 consecutive patients operative exploration was performed in cases where arthrography and/or a delayed physical examination showed positive findings. In all patients arthrography was performed within 48 h after trauma. To determine interobserver agreement, all arthrograms were independently evaluated by two radiologists, both ignorant of the first assessment. RESULTS: The prevalence of an ankle ligament lesion was found to be 76%. Of the 122 patients with a rupture of one or more ankle ligaments, 52% had an isolated anterior talofibular ligament lesion, 3% had an isolated calcaneofibular ligament lesion, and 45% had combined lesions. The site of the lesion was predominantly intraligamentous. In the determination of the presence or absence of an ankle ligament lesion, the specificity and sensitivity of the ankle arthrogram were 71% and 96% respectively. Interobserver agreement on the arthrogram was very good (kappa 0.9). In 1% of patients a clear diagnosis was not possible by means of arthrography. CONCLUSION: Arthrography provides information of high diagnostic quality with excellent interobserver agreement and therefore remains the gold standard for early diagnosis (within 48 h) of a lateral ankle ligament rupture.

Adolescent↗
PubMed1994

Using an expert system to ensure accurate third-party reimbursement.

Many hospitals experience difficulties with Medicare reimbursements tied to payments strictly related to a diagnosis related group (DRG) in which a patient's stay is grouped or assigned. Potentially compounding these difficulties, many large third-party payers have also adopted the DRG system. A lack of knowledge of the intricacies of the DRG system on the part of physicians, administrators, or medical records managers often can lead to hospitals receiving considerably less reimbursement than they are entitled. A computerized coding system that incorporates an expert system can substantially increase reimbursements by simplifying the coding process, identifying overlooked diagnoses, and identifying any missing procedures.

Diagnosis-Related Groups↗
PubMed1993

Population estimates for responses of cutaneous mechanoreceptors to a vertically indenting probe on the glabrous skin of monkeys.

Recordings were obtained from low-threshold mechanoreceptive afferents during stimulation with a 0.5-mm-diameter probe at the receptive field (RF) center and at different distances from the point of maximal sensitivity. At each location, force-controlled stimuli of 0.5-4.0 g were ramped on to a plateau and then off at rates of 1, 10, and 100 g/s. The properties of rapidly adapting (RA) and slowly adapting type I (SAI) mechanoreceptors, when stimulated at the RF center, were similar in many respects to those reported in previous studies. Controlled stimulation away from the RF centers revealed that RF size for RAs was primarily dependent upon ramp rate, and for SAIs the size of the RF was primarily dependent upon load (force). The action potentials from individual afferents during stimulation at each location were binned in time and assigned to spatial segments of 1 mm. These responses were multiplied by: (A) an annular area of the receptive field and (B) the innervation density for the afferent type and skin region. The calculations provided estimates of overall rates of activity among the population of cutaneous afferents that respond to indentation by a small probe. Important differences were obtained between the responses of the population of afferents activated by the trapezoidal stimulus and the responses of afferents stimulated only at the RF center. Populations of tactile afferents provide more information for rate and intensity (force) discriminations than is available from units stimulated at the RF center. For RA afferents, the exponent of the power function describing relationships between stimulus rate and the population discharge (in impulses per second) was 0.3 times greater than the exponent for responses to on-center stimulation. For SAI mechanoreceptors, the exponent of the power functions for static responses to force was 0.22 times greater for the population response than for on-center activation. Population functions for RA responses to the rate of force application and for SAI responses to static load saturated less than comparable responses to stimulation of the RF center. Thus, the coding capacity of the population extends the range of tactile discriminability. The slope and range of stimulus-response functions for populations was enhanced relative to responses to on-center stimulation. This occurs because of recruitment of afferents with RF centers adjacent to and remote from the stimulus, depending upon thresholds and receptive field sizes for different stimulus parameters. With stimulation at increasing rates and forces, there is a progressive spatial recruitment of receptors.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMed1993

Relationships between touch sensations and estimated population responses of peripheral afferent mechanoreceptors.

Trapezoidal indentations of the skin by a 0.5-mm-diameter probe were presented at different rates and loads (forces) to the human fingertip, in order to compare estimates of population responses of cutaneous mechanoreceptors with the quality and magnitude of tactile sensations. The subjects were first trained to attend to and evaluate variations in the magnitude of touch sensations associated with the onset ramp, the plateau period, and the offset ramp. They examined a series of line drawings that illustrated a variety of temporal profiles for sensation magnitude. The line drawings provided a straight-forward means of describing temporal fluctuations of sensation intensity, which corresponded well to psychophysical ratios that were determined subsequently with a matching procedure. Influences of ramp rate on qualities of touch sensations were evaluated by tabulating verbal descriptions of sensory experiences. Each of three rate conditions generated a different quality of sensation during the dynamic portions of stimulation. Onsets and offsets at 100 g/s were described as "taps". During ramps at 10 g/s the quality was described as "rolling" or "moving". At 1 g/s no sense of motion was detected; instead, a "pressure" sensation was identified. Touch sensations during the plateau were always described as a pressure. The subjective magnitudes of touch sensations associated with the onset, plateau, and offset were equated by comparing different components of paired stimuli. At 100 g/s, when subjects matched the offset sensation from the first of a pair of stimuli with the onset sensation from the second, the force of the stimulus producing the offset sensation was 1.3 times greater than the intensity of the stimulus that produced the onset sensation. Matching of the plateau sensation (evaluated during the last 1.5 s of the 2.5-s plateau period) with the onset sensation required a plateau stimulus that was 1.7 times greater in force than the stimulus which produced the onset. Comparison of stimulus intensities producing a match of plateau and offset sensations with stimulus intensities predicted from the previous matches (onset versus offset and onset versus plateau) demonstrated a mean within-subject error of 4%. The mean ratio of plateau to offset forces that produced a match was 1.8:1.3. In a matching procedure in which subjects compared the subjective magnitudes of plateau sensations following onset ramps of different rates, onset ramp rate significantly influenced the magnitude of pressure sensations. The ratios of plateau forces which produced equal magnitudes of sensation following 1, 10, and 100 g/s ramps were 1.6:1.3:1.0.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Mechanically insensitive afferents (MIAs) in cutaneous nerves of monkey.

A problem in the study of nociceptors is that intense stimuli are used to locate the receptive field (RF), and thus the receptor may be damaged before the first responses are recorded. In addition, some nociceptors do not respond to the mechanical stimuli often used to search for the RF. To overcome these problems, an electrical search technique was developed to locate the RF of cutaneous nociceptors. In the hairy skin of anesthetized monkey, we used this technique to locate the RF of 63 A delta-fibers and 22 C-fibers that had extremely high thresholds or were unresponsive to mechanical stimuli. We refer to these afferents as mechanically insensitive afferents (MIAs). Ten A delta-fiber MIAs had a short latency response to stepped heat stimuli and could be responsible for first pain sensation. Five A delta-fiber MIAs and one C-fiber MIA did not respond to mechanical or heat stimuli but did respond to injection into the electrical RF of an artificial inflammatory soup containing histamine, bradykinin, prostaglandin E1, and serotonin. These chemoreceptors might be responsible for the pain and itch sensations that result from chemical stimuli. Some MIAs became more responsive to mechanical stimuli after injection into the RF of the inflammatory soup and, thus, may contribute to the hyperalgesia to mechanical stimuli associated with cutaneous injury. A large proportion of the A delta-fiber (48%) and C-fiber (30%) afferents in this study were insensitive to mechanical stimuli. The role of these MIAs in sensation needs to be studied further. The electrical search technique enables a systematic study of these afferents to be performed. This technique may also be of use to identify and characterize dorsal horn neurons that have inputs from MIAs.

Action Potentials↗
PubMed1990

Contributions of arachidonic acid derivatives and substance P to the sensitization of cutaneous nociceptors.

1. The role of presumed chemical mediators of inflammation in the heat-induced sensitization of cutaneous C-polymodal nociceptors (CPNs) was examined in a rabbit ear preparation maintained in vitro by intra-arterial perfusion with a solution free of protein and cellular elements. 2. In this preparation, CPNs consistently showed enhanced responsiveness after repeated exposure of their receptive fields to noxious levels of heat. The average magnitude of sensitization was quantitatively similar to that observed in vivo, suggesting that blood-born factors are not essential for development of sensitization. 3. Sensitization in one-half of randomly selected CPNs was blocked or reduced when the perfusate contained a cyclooxygenase inhibitor, indomethacin or dipyrone, or the dual cyclooxygenase/lipoxygenase inhibitor, BW755C, even though initial responsiveness to heat and pressure was unaltered. These observations suggest that arachidonic acid breakdown products, possibly prostaglandins, are intermediaries in the sensitization of some, but not all, C-fiber nociceptors of the skin. In addition, heat-induced sensitization for some C-fiber cutaneous nociceptors is the result of processes that are at least partially independent of those involved in excitation. 4. Substance P (SP) or the putative SP antagonists, [D-Pro2, D-Trp7.9]-SP or [D-Pro2, D-Phe7, D-Trip9]-SP, produced no significant effect on heat-responsiveness or sensitization, although ongoing activity may have marginally increased over control levels after repeated heat stimulations. We conclude that SP in an in vitro preparation is not involved in the enhancement of cutaneous C-fiber nociceptor responsiveness after repeated thermal insults.

4,5-Dihydro-1-(3-(trifluoromethyl)phenyl)-1H-pyraz↗
PubMed1985

Effects of spinal lesions on temporal resolution of cutaneous sensations.

In order to test the possibility that the dorsal columns (DCs) contribute to temporal resolution of tactile stimuli, Macaca speciosa monkeys were trained to discriminate different frequencies of stimulation delivered to the glabrous surface of the left foot. Brief (11-msec) pulses of 550-micron indentation from the skin surface were presented for 1 sec at a standard rate of 10 pulses per second (pps), and subsequent trains of the same duration either were replications of the standard or consisted of a higher (comparison) frequency of up to 35 pps. Correct performance consisted of a lever press in response to the comparison stimulus when it occurred as the second or third train in a trial. Signal detection analysis of response tendencies in the second stimulus interval revealed difference threshold values of 2.8 pps, on the average, for 75% correct responding. Transections of the ipsilateral dorsolateral column or the contralateral anterolateral column or both did not significantly affect discrimination of the frequency of cutaneous stimulation. However, following interruption of the ipsilateral DC, two monkeys could not discriminate 10 from 35 pps throughout testing for more than 1 year. These results contrast with a preservation of spatiotactile resolution that has been demonstrated repeatedly for animals following lesions of the DCs or the lateral columns, indicating that a unique function of the DC pathway relates to temporal coding.

Afferent Pathways↗
PubMed1983

Effects of spinal tractotomy on spatial sequence recognition in macaques.

Five Macaca speciosa monkeys were trained to discriminate between the order of two tactile stimulus presentations (proximal-distal vs. distal-proximal) to the lateral calf. Psychophysical thresholds for tactile sequence recognition were obtained by varying the distance between the spots stimulated. Stabilized preoperative thresholds for stimulation on the lateral calf averaged 10.4 mm, which is comparable to point localization thresholds for sequential contact of the proximal limbs of humans. Complete interruption of the ipsilateral fasciculus gracilis produced elevations of thresholds within the first 3 postoperative weeks to an average of 3.6 times the control values. With training over 6 postoperative months, normal discrimination recovered. In contrast to the effects of dorsal column (DC) lesions, interruption of the lateral and ventral columns ipsilaterally or contralaterally produced no deficit or a mild and transient deficit. Monkeys with isolation of either the ipsilateral dorsolateral column (ILC) or the contralateral ventral quadrant (CVQ) exhibited substantial and enduring deficits. Thresholds were elevated an average of 5 times the control values, and recovery was not observed or was incomplete after months of training. In contrast, isolation of the ipsilateral dorsal column produced little or no threshold elevation. The results of isolating lesions complement the series of primary lesions to each cord sector, showing that spatiotactile sequence recognition for the hindlimb is served more critically by the dorsal columns than by the lateral columns.

Animals↗
PubMedDate not supplied

Herniography in 79 patients with unexplained pain in the groin: a retrospective study.

To assess the safety and accuracy of herniography for the diagnosis of inguinal hernia in young military men with unexplained pain in the groin, a retrospective study in 79 patients with unexplained pain in the groin who underwent a herniography is presented. Nineteen patients (24%) showed a positive herniogram which was confirmed in 15 out of 16 patients who subsequently underwent surgery. All 60 (76%) patients with a negative herniography were followed-up. An inguinal hernia was subsequently found at surgery in two patients out of eight who were operated on later. In our series no serious complications occurred. Herniography has been shown to be a safe and reliable method to demonstrate or exclude an inguinal hernia in young military men with unexplained pain in the groin. The differential diagnosis in this specific patient group is discussed.

Adolescent↗