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PubMed1983

Diabetes in pregnancy. Skeletal malformations in the offspring of diabetic rats after intermittent withdrawal of insulin in early gestation.

Precise timing of the teratogenic period in diabetic pregnancy is of clinical importance since correction of the glucose intolerance during this period may protect the offspring from malformations. An experimental approach to elucidate this problem with regard to skeletal development was made in groups of pregnant streptozotocin-diabetic rats (MDI), which were treated with daily insulin injections except for a 2-day period in the first half of pregnancy. The degree of metabolic derangement was estimated by measurements of serum glucose concentrations. During the insulin-free period, the rats showed severe hyperglycemia (greater than 20 mM) while during ongoing insulin treatment, only brief periods of hyper- or hypoglycemia were observed. Insulin treatment was withdrawn successively between gestational days 3 and 12. Control groups consisted of normal pregnant rats (N) or pregnant rats with manifest diabetes (MD) without insulin treatment. The serum glucose levels of the N animals were below 6 mM while those of the MD animals were above 25 mM throughout pregnancy. Skeletal malformations in the viable offspring were recorded on gestational day 20 after Alizarin staining of calcified ossification centers, which also allowed an estimate of skeletal development as a whole. Untreated diabetes in the MD rats induced a high rate of fetal resorptions, a decrease in fetal weight and viability, as well as retardation of skeletal development. Intermittent insulin treatment in the MDI rats ameliorated, but did not abolish, these changes. In the MD group 9 of 48 viable fetuses showed severe malformations of either the lower jaw (micrognathia) or of the lumbosacral region (caudal dysgenesis).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2000

Differences in total protein concentration, nucleated cell count, and red blood cell count among sequential samples of cerebrospinal fluid from horses.

OBJECTIVE: To examine total protein concentration and cell counts of sequentially collected samples of CSF to determine whether blood contamination decreases in subsequent samples and whether formulas used to correct nucleated cell count and total protein concentration are accurate. DESIGN: Case series. ANIMALS: 22 horses. PROCEDURE: For each horse, 3 or 4 sequential 2-ml samples of CSF were collected from the subarachnoid space in the lumbosacral region into separate syringes, and blood was obtained from the jugular vein. Total protein concentration, nucleated cell count, and RBC counts were determined in all samples. RESULTS: Among 3 sequential samples, total protein concentration and RBC count were significantly lower in samples 2 and 3, compared with sample 1. Nucleated cell count was significantly lower in sample 3, compared with sample 1. Among 4 sequential samples, total protein concentration and RBC count were significantly lower in samples 2, 3, and 4, compared with sample 1. Nucleated cell count was significantly lower in samples 3 and 4, compared with sample 1. For 3 correction formulas, significant differences in corrected values for nucleated cell count and total protein concentration were detected between sample 1 and sample 3 or 4. CONCLUSIONS AND CLINICAL RELEVANCE: Because iatrogenic blood contamination decreases in sequential CSF samples, a minimum of 3 samples should be collected before submitting the final sample for analysis. Formulas to correct nucleated cell count and total protein concentration are inaccurate and should not be used to correct for blood contamination in CSF samples.

Animals↗

PubMed2004

Vertebral deformities in female patients with osteoporosis: influence of trauma and bone mineral density.

Aging societies have an increased incidence of fractures caused by osteoporosis. Vertebral compression fractures occur most frequently in the thoracolumbar vertebrae of elderly individuals. The severe pain caused by this type of fracture causes many patients to become bedridden. However, the initial pain generally diminishes after around 1 month and is replaced by dull pain in the lumbar and lumbosacral regions. We carried out a cross-sectional and longitudinal study of these fractures in 328 female outpatients with osteoporosis. All subjects initially presented at our hospital with back pain and bone mineral density measurements were taken using both dual energy X-ray absorptiometry and quantitative computed tomography. Our main findings were as follows. Decreased BMD appears to be one cause of vertebral body deformities. However, we found it difficult to predict whether deformities will progress or cause additional deformities of adjacent vertebral bodies, because the key contributing factors include not only BMD and age but also lifestyle and activity patterns. In addition, none of the drug administration methods investigated here resulted in a notable increase in BMD.

Age Factors↗

PubMed1983

Chromosome translocation (T(2;4)1 Sn)-induced neural tube defects in the mouse embryo.

Neural tube closure was studied in embryos obtained from matings of male mice heterozygous for a reciprocal chromosome translocation (T(2;4)1 Sn) with normal female (CFLP) mice. When litters were examined on the 9th to 12th days of gestation, there was a high incidence of resorption, developmental delay and neural tube closure defects in these embryos. SEM observations indicated that the neural tube closure defects ranged in severity from a side-to-side flattening of the midbrain to extensive anomalies in which the entire cephalic neural tube had failed to close. In addition to cephalic defects, a number of embryos exhibited open defects or abnormal subectodermal blebbing in the future lumbosacral region. In spinal regions, even in areas in which the neural tube had previously closed, it often was irregular and folded. These observations are discussed in relation to studies of gene-related defects of neural tube closure.

Animals↗

PubMedDate not supplied

Spondylocostal dysostosis with perinatal death and meningomyelocele.

A preterm black girl was born at 35 weeks of gestation to a healthy nonconsanguineous couple. She had a very short trunk with disproportionately long extremities, mild prognathism, low-set ears, thoracolumbar meningomyelocele, and imperforate anus. She died 45 min after birth. Roentgenograms revealed hemivertebrae, block vertebrae, severe thoracic lordosis, absent sacrum, posterior fusion of some ribs with greater distance among them in the anterior thorax, and relatively long extremities. Internal examination showed an intact meningomyelocele extending from the first thoracic vertebra to the lumbosacral region, containing 150 mL of clear fluid. The lungs were severely hypoplastic. Spondylocostal dysostosis encompasses a spectrum of vertebral abnormalities ranging from spina bifida occulta to large meningomyelocele and from mild to severe thoracic deformities that produce pulmonary hypoplasia and respiratory insufficiency. Our case is one of the most severe ever described.

Abnormalities, Multiple↗

PubMed1986

Intraspinal lipomas with spina bifida. Prognosis and treatment in 73 cases.

The authors present a series of 73 cases of intraspinal lipomas in the lumbosacral region. Sixty-four patients were operated on, 43 of these under intraoperative monitoring of neural function. The results of this series and of major series published in the past 10 years demonstrate both the potential severity of these lesions (which are responsible for progressive neurological deficits in 56% of affected cases) and the benignity of their surgical treatment. The authors emphasize the usefulness of systematic early surgical treatment of these lesions.

Adolescent↗

PubMed1992

Spinal arachnoid cysts in the pediatric age group: an association with neural tube defects.

Between 1979 and 1991, spinal arachnoid cysts were found in 11 patients aged 19 months to 18 years (mean age 5 1/2 years). Of the 11 patients, six had a myelomeningocele and one diastematomyelia. The presenting symptoms included radicular pain (one patient), progressive weakness (three), increasing scoliosis (one), worsening spasticity (three), and recurrent urinary tract infections and progressive constipation (one). Two patients showed no symptoms from the spinal arachnoid cyst. The distribution of lesions was as follows: cervicomedullary (one patient), cervical (one), cervicothoracic (two), thoracic (four), lumbar (two), and sacral (one). Four of the 11 arachnoid cysts (all intradural) were located anterior to the spinal cord, three of which were in children with a myelomeningocele. Only two of the cysts were extradural; both were found in the lumbosacral region, and one was associated with diastematomyelia. Eight patients were treated with fenestration and/or resection of the cyst wall. Three patients with anterior cysts were treated with shunts, a cyst-to-pleural space shunt in two and a cyst-to-subarachnoid space shunt in one. All of the patients either improved or exhibited an arrest in the progression of their symptoms. Spinal arachnoid cysts are a treatable cause of progressive neurological deficits and, in this series, were frequently found in patients with neural tube defects.

Adolescent↗

PubMed2004

Quantitative analysis of radioisotope cisternography in the diagnosis of intracranial hypotension.

OBJECT: The authors attempted a quantitative analysis of conventional radioisotope cisternography for the purpose of more accurate diagnosis of intracranial hypotension. METHODS: Fifty-seven patients suspected of having intracranial hypotension underwent radioisotope cisternography. Whole-body images were obtained 2.5, 6, and 24 hours after intrathecal injection of 111In-diethylenetriamine pentaacetic acid. Radioactivity in the cerebrospinal fluid (CSF) space was counted during scanning, and radioisotope clearance was studied. Direct signs of radioisotope leakage into the spinal epidural space were found in 25 patients. Most leaks were located in the lumbosacral region. Analysis of the radioisotope clearance curve revealed two different patterns. In patients without a radiographically demonstrated radioisotope leak, absolutely exponential curves were observed (R2 > 0.99). The activity of the radioisotope decreased at a rate of e(-003) to e(-0.107) (mean +/- standard deviation, e(-0.056 +/- 0.018); 32 patients). Clearance in patients with an overt radioisotope leak was not a simple exponential curve; it could be divided into an early rapid phase and a late slow phase. The clearance rate during the first 6 hours was e(-0.219 +/- 0.127) (25 patients) and e(-0.076 +/- 0.021) thereafter. The authors speculated that the early escape of undiluted radioisotope solution through an aberrant CSF outlet, such as a traumatic spinal dural tear, was responsible for this phenomenon. CONCLUSIONS: The quantitative analysis featured in this study seems to be useful in the diagnosis of intracranial hypotension. A small CSF leak below the limit of radioisotope cisternography resolution might be detected using this technique.

Adolescent↗

PubMed2006

Histological study of paramedian dorsal root ganglia in an infant with split cord malformation. Case report.

The authors present a histological study of resected tissue obtained from an 18-month-old girl with split cord malformation Type II whose right foot was smaller than her left. Magnetic resonance imaging revealed duplication of the spinal cord below the level of L-1. On laminectomy it was discovered that the cord was tethered in the lumbosacral region. The resected tissue contained the cluster of paramedian dorsal root ganglia unique to this congenital anomaly. On histological examination, the ganglion cells expressed not only neuronal markers but also a marker for muscle cells indicative of pathological development of the midline structure. Further histological study is necessary to gain a deeper insight into this congenital disease and to obtain additional information for use in surgical planning.

Female↗

PubMed1994

Diastematomyelia--clinical manifestation and treatment outcome.

Diastematomyelia is a rare congenital anomaly characterized by a division of the spinal cord or the filum terminale into two parts. In Korea, only one case has been reported. The authors have operated on 5 cases of diastematomyelia with septum since July, 1978. The ages ranged from 1 to 44 years (median; 11 years). There were 2 boys, 2 girls and an adult man. The disease manifested by cutaneous abnormalities and neurological or orthopedic deficits. Pain was a chief complaint in the adult patient. The symptoms had progressed in 3 cases. The diagnosis was made correctly by CT myelography or MRI in 4 cases. The median septum was located at the lumbar area in 4 cases and at the lumbosacral region in 1 case. Associated abnormalities included low lying conus (5 cases), lipoma (2 cases), thickened filum terminale (1 case), hemilipomyelomeningocele (1 case) and syrinx (1 case). The median septum was removed. The dural sleeve adjoining the septum was resected and the dural sac was reconstructed. The role of MRI in the diagnosis and planning of surgery and the high frequency of associated low lying conus were emphasized. Though the surgical treatment relieved pain, it did not reverse the neurological deficits or orthopedic deformities significantly, which suggests the beneficial effects of early surgical intervention in the cases with progressive symptoms.

Adolescent↗

PubMedDate not supplied

[The application of a synthetic index of exposure in the manual lifting of patients: the initial validation experiences].

Via a multicentre study coordinated by the EPM research group carried out in 216 wards in a total of 56 hospitals, old peoples homes and geriatric departments, it was possible to quantify exposure to patient handling (classified in 4 classes: 0-1.5 negligible, 1.51-5 slight to average, 5.01-10 average to high, > 10 elevated), and at the same time identify the damage to the lumbosacral spine thus caused. Both assessment of exposure and identification of health impairment were carried out using homogeneous methods. Subjects with work seniority in the job of less than 6 months and subjects who had been transferred because of back trouble were excluded from the study. It was therefore possible to carry out two types of study to assess the association between exposure and impairment. In study A, covering 3021 subjects, an analysis was performed of the association between exposure index, positive response to the anamnestic threshold for lumbosacral disorders and acute low back pain using the method of logistic analysis to obtain the prevalence odds ratios. In study B, covering 418 subjects, the analysis of association was performed on the incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain, assuming that exposure in the wards had remained constant. The technique used was Poisson regression, thereby calculating the relative incidence rate ratios. Both for PORs and IRRs the reference group consisted of the exposure class judged as negligible (exposure index 0-1.5). The results showed that the PORs calculated for positive lumbar threshold were significant for increasing exposure classes with a positive trend for the second and third exposure class but not for the last, presumably due to a healthy worker selection effect. Neither in Study A nor in Study B were any associations observed between exposure and acute low back pain occurring in the previous 12 months: this may be due to the fact that the impairment indicator does not appear to be appropriate in terms of latency period. A different result was obtained in Study B which showed a good association between exposure and incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain according to department. The IRRs showed a positive trend both for acute episodes (IRR: 1.932, 2.439, 2.847) and for acute plus pharmacologically controlled acute episodes (1.798, 1.830, 4.523). On the basis of these results, even with the caution required for the reasons explained in the text, it seems to be possible to identify three grades of exposure which correspond to increasing probability of impairment of the lumbosacral region of the spine: the first where risk seems negligible corresponds to an exposure level between 0 and 1.5. The second, where the episodes of low back pain may occur with an incidence 3.8 times greater, corresponds to an exposure level between 1.51 and 5, and the third corresponds to exposure levels exceeding 5, where the episodes of low back pain may occur with an incidence up to 5.6 times greater than expected.

Acute Disease↗

PubMedDate not supplied

[The assessment of exposure to the risk of the manual lifting of patients and the results of clinical studies in the hospitals of Bolzano and Bressanone].

A study was made in two hospitals in the province of Bolzano in order to ascertain the possible relationship between risk due to manual lifting of patients and occurrence of back disorders in healthcare workers. Risk analysis was carried out in 16 wards, with 207 workers assessed by means of clinical/anamnestic check-up of the spine. In the majority of the wards analysed the index of exposure to patient lifting was average or high due mainly to the lack of equipment, unsatisfactory structures and furnishings, and organizational factors. This was particularly evident in the Bressanone hospital where there were fewer workers to each department. As regards the clinical assessment of the spine, from the overall analysis of the results it was seen that in the hospital in Bressanone the prevalence of degenerative disorders of the lumbosacral region of the spine was 3.9% and in the Bolzano hospital it was 5.7%. Similar differences were observed in the prevalences of episodes of acute low back pain reported in the previous 12 months: Bressanone 7.7%, Bolzano 3.8%. In both hospitals 3rd grade SAP was diagnosed in about 5% of the subjects examined and globally clinical/functional alterations of the lumbar spine were observed in 20% of the Bressanone workers and in 27.2% of the Bolzano workers. Management of the cases judged unfit for manual lifting of patients was particularly difficult because of the high percentage of such cases (8-9%). On the basis of these results, the administrations of both hospitals undertook a series of short-, medium- and long-term interventions in order to reduce the risk for the spine.

Adolescent↗

PubMed1999

[Radiological imaging in lumbago and sciatica].

Low back pain and sciatica are among the most common medical problems in Western countries, affecting up to 80% of the population at some time during their lives. Plain radiography is still a sensitive method in degenerative spinal disease and for the identification of spondylolysis and destructions as well as transitional vertebra and other anomalies in the lumbosacral region. In lumbar disk herniation, CT and MR have higher sensitivity than lumbar myelography, and should be used as the primary imaging methods. Myelography is still the method of choice in lumbar spinal stenosis. Myelography should also be considered in patients with poor consistency between CT or MR findings and the clinical presentation. Postoperatively, MR is superior to CT and myelography for distinguishing between scar tissue and recurrent disk herniation.

Epidural Space↗

PubMedDate not supplied

[Lumbar disk herniation treated by microsurgery].

Microsurgical technique was applied in 46 cases of lumbar disc herniation in the years 1993-1994. The group comprised 17 women and 29 men aged 17-46 years (mean age 39.54 +/- 8.72). Sciatic pain was present in 39 (85%) cases, in the remaining ones low back pain was the main symptom. Neurological deficit signs were noted in 21 (46%) cases. The authors discuss the indications to microdiscectomy, the microsurgical technique and outcomes. Microdiscectomy was carried out in cases selected strictly according to the result of neurological examination and radiological findings X-ray of lumbosacral region in 46 cases (100%), myelography in 11 (24%), CT in 4 (9%) and MRI in 31 (67%). MRI served for evaluation of signal intensity, site and site of disc hernia. In 31 cases the operation was done in patients with recognized unilateral and one-level disc hernia. Full remission of complaints was noted in 45 patients during follow-up over 2 years.

Adolescent↗

PubMed1976

[Atypical symptoms in spinal tumors--peripheral and pseudoperipheral symptoms (author's transl)].

Sciatic symptoms and positive sciatic findings may represent a leading, but at the same time missleading symptom of a spinal tumor in every possible level for months and years ahead. The study of literature--so far scarcely taken notice of in German speaking Countries--as well as own observations lead to an organisation or array of the atypical symptoms, i.e. remote symptoms of tumors above the 12th thoracic vertebra shown as predominantly "central pseudoperipheral sciatica", more rare general peripheral findings in the lumbosacral region due to early tumoral irritation of the spinothalamic tract or the dorsal funiculi or congestional changes of the spinal fluid as well in the vascular apparatus. Tumors below the level of the 12th thoracic vertebra show an almost indistinguishable mixture of remote and local symptoms of the above nature preceeding typical clinical tumor manifestations.

Adult↗

PubMed1999

[Diagnostic imaging in lumbago and sciatica].

Humans↗

PubMed1999

The effects of calcium channel blocker, flunarizine on spinal reflexes in the cats.

Effects of calcium channel blocker flunarizine on spinal monosynaptic reflexes were investigated in spinal cats. Flunarizine was administered locally into the spinal cord (10, 50, 100 microM) and intraperitoneally (5, 10, 20 mg/kg). Adult cats (n = 10), weighing 1.5-3 kg were anesthetized with ketamine (50 mg/kg, i.m.) and artificially ventilated. Animals were spinalized at C1 level. A laminectomy was performed in the lumbosacral region. The ventral and dorsal roots of segment L5 were isolated and a pouch of skin was formed at the site of the dissection to allow the exposed tissues to be covered with liquid paraffin. The temperature was kept at 38.5 degrees C with a heating pad. A polyethylene cannula was introduced into the left carotid artery to monitor blood pressure, which was kept above 100 mmHg. The dorsal root of segment L5 was placed on a silver-silver chloride wire electrode for stimulation through an isolation unit. The reflex potentials were recorded from the ipsilateral L5 ventral root, mounted on a silver-silver chloride wire electrode. The systemic (5, 10, 20 mg/kg) and local (50 and 100 microM) dosages of cinnarizin derivative flunarizine significantly decreased the amplitude of reflex response (p < 0.05). Moreover, the latency of the monosynaptic reflexes was increased after administration of the drug (p < 0.05). Voltage-dependent calcium channels in the spinal cord may play an important role to regulate reflex respond.

Animals↗

PubMed2001

History of surgery for ruptured disk.

The history of surgery for ruptured disk of the human spine began approximately a century ago. Advances in the understanding of symptoms and signs of root or cord compression, their relationship to the pathology, and the refinement in imaging techniques have contributed to the present surgical management of rupture disk disease. Historical findings relevant to the cervical, thoracic, and lumbosacral regions of the spine, with relevant pathophysiology, imaging, and surgical treatment, including the evolution of various surgical approaches are discussed. Surgeons and other contributors in the medical field are cited for their respective contributions to the evolution of the present operative approaches for disk ruptures in the cervical, thoracic, and lumbar spinal regions.

Diskectomy↗