PubMed Health⌕ Search

Biomedical subjects

T W McNeill

Publications and source records attributed to T W McNeill.

16 recordsLinked to original sources
PubMed1995

Epidural administration of methylprednisolone and morphine for pain after a spinal operation. A randomized, prospective, comparative study.

The results of postoperative epidural administration of saline solution (a placebo), morphine, methylprednisolone, and a combination of morphine and methylprednisolone for the reduction of pain after an operation for spinal stenosis or a herniated intervertebral disc were compared in a prospective, randomized blinded study. Epidural administration of morphine and methylprednisolone--either alone or in combination--significantly reduced the need for analgesia after an operation for spinal stenosis (p < 0.05) but not after an operation for a herniated intervertebral disc. Morphine and methylprednisolone did not have an addictive effect on the reduction of pain. Itching was significantly more common in the patients who had received morphine than in those who had received the placebo (p = 0.04). Although urinary retention was more frequent after the use of morphine than after the use of the placebo, the difference was not significant with the size of the sample that was analyzed (p = 0.25).

Adult↗
PubMed1994

The dose-related effect of intradiscal chymopapain on rabbit intervertebral discs.

STUDY DESIGN: This study analyzed the histological and biochemical responses of intervertebral disc tissue to intradiscal injection of varying amounts of chymopapain. OBJECTIVE: To determine the appropriate amount of chymopapain needed to accomplish effective degradation of proteoglycans (PG) in the nucleus pulposus of intervertebral discs. SUMMARY OF BACKGROUND DATA: Chymopapain is an accepted treatment alternative for patients with disc herniations. The recommended clinical dose of 2,000-4,000 pKats per injection is derived from early animal studies and empirical results in man. A lower effective dose could reduce the complication rate while providing similar clinical results. METHODS: Twenty to 4,000 pKat of chymopapain was injected into rabbit discs, and the level of keratan sulfate (KS) epitope in serum was measured at different times after the injection. The animals were killed after 6 days and the injected and two neighboring discs were examined histologically. RESULTS: The serum KS level did not change appreciably after injection of 20 pKat, rose moderately at 100 and 200 pKat, and rose strongly at 500 pKat. Doses greater than 500 pKat did not result in further increase in the KS level. CONCLUSION: Degradation of the disc proteoglycans is dose dependent and reaches a maximum at 500 pKat. Higher doses appear not to cause further loss of aggrecan molecules, and injection of more than 1,000 pKat produces significant annular destruction.

Animals↗
PubMed1990

Discs degenerate before facets.

The purpose of this study was to determine the relationship between facet joint osteoarthritis and disc degeneration in subjects in whom both MRI and CT scans had been obtained. The MRI scans were used to determine disc degeneration, the CT scans to determine facet joint osteoarthritis. It was hypothesized that disc degeneration would sometimes occur without the presence of facet joint osteoarthritis, but that facet joint osteoarthritis would only occur in the presence of disc degeneration. Sixty-eight sets of scans were included and 330 discs and 390 facet joints were evaluated. There were 144 degenerated discs and 41 levels with facet osteoarthritis. Disc degeneration without facet osteoarthritis was found at 108 levels, while all but one of 41 levels with facet degeneration also had disc degeneration. That one exception occurred in a patient with advanced Paget's disease. Disc degeneration and facet osteoarthritis both were found to increase with increasing age. There was no difference between women and men. Degeneration at the L4-5 and L5-S1 levels was significantly more prevalent than at the L3-4 levels, while degeneration at the L3-4 level was significantly more common than at the L1-2 and L2-3 levels. We conclude that disc degeneration occurs before facet joint osteoarthritis, which may be secondary to mechanical changes in the loading of the facet joints.

Adolescent↗
PubMed1989

The effect of chemonucleolysis on serum keratan sulfate levels in humans.

Sensitive measurements of serum keratan sulfate (KS), a glycosaminoglycan found in large quantities in the proteoglycans of human cartilage, can be obtained using an enzyme-linked immunosorbent-inhibition assay. Patients who are undergoing chemonucleolysis (CN) provide a clinical opportunity to monitor the large-scale proteolytic degradation of cartilage. By measuring serum KS levels both pre- and post-CN, we have demonstrated that serum KS levels rise predictably after CN, in a manner that reflects major catabolic events of cartilage.

Adult↗
PubMed1986

Psychologic classification of low-back pain patients: a prognostic tool.

The Pain Drawing Test and Back Pain Classification Scale (BPCS) were examined for their degree of correspondence in measuring psychologic disturbance and for their value in predicting treatment outcome in four areas: medication need, work status, patients' rating of improvement, and change in pain over a 12-month period. Agreement between the two measures in identifying patients as "not psychologically disturbed" was good; agreement was far less for patients identified as "psychologically disturbed." At the same time, both measures predicted clinical outcome with an equal degree of accuracy across the measures of outcome, except for "return-to-work status" where significant group trends with the BPCS did not reach significance with the Pain Drawing Test. The strong correlation between the two measures in predicting clinically important indexes of improvement suggests that differences in diagnosing the psychologically disturbed does not represent error. The difference may arise because the two scales tap different aspects of psychologic disturbance. Both scales appear to be of clinical value in the early identification of probable treatment failures.

Adult↗
PubMed1974

Controlled hypotensive anesthesia in scoliosis surgery.

In a retrospective study comparing normotensive (twenty-two patients) and controlled hypotensive (forty-four patients) anesthesia for spine fusion and Harrington instrumentation, the use of hypotensive anethesia was found to decrease the need for blood replacement and total blood loss by an average of 40 per cent and to reduce the average operating time by more than thirty minutes. No complications attributable to the anesthetic technique occured.

Adjuvants, Anesthesia↗
PubMedDate not supplied

CT demonstration of cervical diastematomyelia.

Cervical diastematomyelia, a rare anomaly, was found in a 14-year-old girl with congenital scoliosis. Metrizamide myelography and metrizamide CT demonstrated anomalies of the cervical spine and a split cervical cord within a single dural tube, without the presence of a fibrous, cartilaginous, or bony spur.

Adolescent↗
PubMedDate not supplied

Organic status, psychological disturbance, and pain report characteristics in low-back-pain patients on compensation.

The relationship betewwn compensation and three variables--psychologic disturbance, organic status, and pain report characteristics--was assessed. Patients on compensation were clinically similar to patients not on compensation in the relative frequency of cases of psychologic disturbance and nonorganic findings in each group. Patients on compensation differed only when objective evidence of organic disease and psychologic stability was present. Under these circumstances, the compensation group used 43% more words to describe their pain and endorsed more pain qualities on five independent dimensions of pain. These results indicate that compensation primarily affects the description of low-back pain in cases where objective evidence of injury is present and leads to an intensification of sensory discomfort. Little justification was found for the atmosphere of suspicion that surrounds patients on compensation who have no evidence of organic disease.

Adult↗
PubMedDate not supplied

The Rush-Presbyterian-St. Luke's lumbar spine analysis form: a prospective study of patients with "spinal stenosis".

A form for accurate and reproducible record keeping was introduced into the orthopedic practice of one author at Rush--Presbyterian--St. Luke's Medical Center (RPSLMC) in 1976 and has been used in the evaluation of each new patient with a lumbar spine problem since that time. In order to demonstrate the usefulness and effectiveness of this form, a small subset of these patients (i.e., those with "spinal stenosis") who had had decompressive surgical treatment were recalled, reexamined, and the form redone completely. The format of the form then was changed (without changing the content) in order to give a numeric score to the various clinical subcategories covered in the history and physical examination. Within the parameters studied, significant changes were found in both of the major categories of pain and objective physical findings. This suggested that patients with "spinal stenosis" obtained definite, measurable benefit from surgical decompression during the period of 1-3 years following their surgery.

Data Collection↗
PubMedDate not supplied

Chemonucleation and changes observed on lumbar MR scan: preliminary report.

This study examines the relation between the postchemonucleation clinical outcome and changes observed on the lumbar MR scan. Eight of 12 chemonucleated disks showed clinical improvement at the last follow-up, while the other four showed no improvement. In the cases that showed improvement there was a decrease in one or both dimensions of the defect in the thecal sac. Seven of eight showed an increase in the peridisk signal. Where there was no clinical improvement there were fewer decreases in the size of the defect, and three of four showed no increase in the peridisk signal.

Adolescent↗