PubMed · 14869249
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R N de FIGUEIREDO. [Anesthesia].. https://pubmed.ncbi.nlm.nih.gov/14869249/
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STUDY DESIGN: Electrophysiologic recordings were obtained from low threshold primary afferent neurons innervating lumbar multifidus and longissimus muscles in the anesthetized cat. OBJECTIVE: The purpose of this study was to classify sensory nerve endings in lumbar paraspinal muscles and characterize their responses to biomechanical loads applied over a range of durations that encompass those occurring during spinal manipulation. SUMMARY OF BACKGROUND DATA: Neural responses arising from the mechanical input during spinal manipulation are thought to contribute to this maneuver's therapeutic effects. Because manual therapies are distinguished to a large extent on the basis of the speed with which they are applied, it is important to understand how their rate of application affects the signaling properties of primary afferent neurons innervating paraspinal tissues. If alterations in sensory input do contribute to the mechanism of spinal manipulation's therapeutic effect, it seems reasonable to expect that these primary afferents would respond to spinal manipulation in some unique fashion. METHODS: Experiments were performed on 6 adult cats. A L4-L5 laminectomy was performed and the L6 dorsal roots exposed. The L6-L7 vertebrae and associated paraspinal tissues remained intact bilaterally, including lumbodorsal fascia, multifidus, longissimus, iliocostalis muscles, and deeper tissues. Forceps were clamped tightly onto the lateral surfaces of the L6 spinous process through a thin narrow, slit in the lumbodorsal fascia. Single unit afferent activity was recorded from fine filaments teased from the L6 dorsal root. Instantaneous discharge frequency was calculated. Afferents were classified based on von Frey threshold, conduction velocity, and responses to direct muscle stimulation and to succinylcholine injection. Spinal manipulative-like loads were applied to the L6 vertebra (posterior to anterior) using a programmable electronic feedback control system. Force-time profiles were half-sine waves with durations of 25, 50, 100, 200, 400, and 800 milliseconds delivered at constant magnitudes of 33%, 66%, or 100% body weight. RESULTS: The 6 afferents were classified as low threshold mechanoreceptors based on von Frey thresholds being less than 6 g. Five afferents were Group I or II muscle proprioceptors and one afferent was a Group III muscle mechanoreceptor. The receptive field for 2 of the 6 afferents was in the multifidus muscle and the receptive field of the remaining 4 afferents was in the longissimus muscle. In general, the mean instantaneous discharge frequency for all 6 afferents increased abruptly as the duration of the impulse approached 100 milliseconds. An increase in loading magnitude (33% vs. 66% vs. 100% body weight) did not appear to systematically affect the discharge from the 6 low threshold mechanoreceptors. CONCLUSIONS: This preliminary report suggests that abrupt changes in neural discharge (instantaneous frequency) of low threshold muscle mechanoreceptors of the lumbar spine occur as the duration of a biomechanical load approaches that typically used during spinal manipulation. These changes could comprise part of the mechanism contributing to this intervention's physiologic effects. Further studies are warranted to better understand the signaling properties of a wider range of sensory receptors as well as determine the central effects of these high frequency discharges.
Shone's anomaly was first described in 1963 as a developmental complex of four potentially obstructive cardiac lesions including a supravalvular fibrous mitral ring, deformity of the mitral and/or subvalvular apparatus, subvalvular aortic stenosis and coarctation of the aorta. While paediatric patients with Shone's anomaly have been reported in the literature, only a few adult patients presenting with this anomaly have been described in the perioperative period. However, patients with an undiagnosed, incomplete form of Shone's anomaly might occasionally present for non-cardiac surgery as adults. In this case report we describe the anaesthetic management of an adult patient scheduled for a non-cardiac operation, who suffered from Shone's anomaly that was unrecognised prior to the operation.
BACKGROUND: The measures for quality assurance in haemotherapy developed at the Charite Campus Mitte according to the transfusion law of 1998 are introduced and discussed. METHODS: In a 3-year study period the submission of transfusion documentation and the expiration of blood products were compared to the year 2001. The potentials for improvement for 2001-2003 were compared based on evaluation of the self-inspection documentation of the transfusion clinics. RESULTS: The submission rate for the transfusion documentation increased from 90% in 2001 to 98.3% in 2002 and 2003. The expiration of blood products decreased from 5.1% in 2001 to 1.7% in 2003 resulting in a cost reduction from 140,000 Euro to 50,000 Euro. Continuous need for improvement was found for the prescribed annual further education of staff on quality management. CONCLUSIONS: The self-inspection procedure in transfusion clinics still revealed potential for improvement, although documentation of transfusions were improved and the expiration of blood products and the resulting costs were substantially reduced.