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PubMed1981

Noninvasive assessment of left ventricular performance in patients with ischemic heart disease: ear densitographic study during uninterrupted treadmill exercise.

Among 738 consecutive patients with chest pain referred for exercise testing, only 17 men fulfilled strict criteria for this pilot study: (1) achievement of at least 90 percent of age-predicted maximal heart rate or electrocardiographic criteria for a positive test; (2) subsequent coronary angiography; (3) exclusion of prior heart disease; and (4) absence of medication. Measurements of systolic time intervals obtained with ear densitography during early exercise differentiated 10 patients with coronary artery disease (Group 1) from 17 men (7 patients plus 10 normal volunteers) with normal coronary arteries (Group 2). Despite nearly identical heart rate and blood pressure responses in both groups, men in Group 1 had a significantly greater reduction of preejection period (PEP) at 1 minute and 4 minutes as well as a greater decrease in PEP/LVET (left ventricular ejection time) ratio. Differences were most significant when expressed as percent change of PEP/LVET ratio from control value (p less than 0.001 at both 1 minute and 4 minutes). After 4 minutes, men in Group 1 had no further decrease in PEP/LVET ratio and in 8 of the 10 men PEP/LVET ratio then increased to peak exercise. By contrast, PEP/LVET ratio continued to decrease to peak exercise in men in Group 2. The early floor in PEP/LVET ratio in Group 1 represents limited functional reserve and the subsequent increase suggests functional deterioration. Thus, densitographic systolic time interval measurements during uninterrupted exercise in unmedicated subjects appear to improve the sensitivity and specificity of the conventional treadmill test.

Adult↗

PubMed1976

Splenic abscess. Report of 10 cases and review of the literature.

Ten cases of splenic abscess seen between 1964 and 1974 are reviewed. Pain referable to the abscess was the most common symptom, but was present in only five cases. Fever was present in all but one case. Tenderness in the region of the spleen was noted in six cases, in three cases the spleen was palpable and in one case a large mass in the upper left quadrant of the abdomen was palpated. Abdominal films were suggestive of the diagnosis in two cases, and the liver-spleen scan demonstrated a defect in three cases. Seven abscesses were caused by gram-negative bacilli of bowel origin; the etiologic agents in the other three were Staphylococcus aureus, Streptobacillus moniliformis and a Nocardia species. Associated conditions predisposing to splenic abscess included trauma in three cases, splenic arteritis or embolization in five cases, and foci of infection elsewhere in the body in six, including two cases of endocarditis. The mortality was 60 per cent. Half of the deaths were due to the underlying illness, but failure to diagnose splenic abscess contributed to a fatal outcome in three cases.

Abscess↗

PubMed1977

Responses of thoracic dorsal horn interneurons to cutaneous stimulation and to the administration of algogenic substances into the mesenteric artery in the spinal cat.

The effects of the injection of algogenic substances (bradykinin, acetylcholine) into the inferior mesenteric artery were studied at the thoracic level on 47 dorsal horn interneurons responding to cutaneous stimulation. Each unit was characterized by its electrophysiological properties and carefully located within the cord by extracellular injection of pontamine sky blue. Twenty cells, driven only by non-noxious cutaneous stimulation and mainly located in lamina IV, were not affected by the administration of algogenic substances. The activity of 25/27 cells, excited by both non-noxious and noxious cutaneous stimulation and mainly located in lamina V, was strongly modified by nociceptive visceral stimulation, induced by bradykinin and acetylcholine: 8/27 cells were activated, 14/27 were inhibited, 3/27 had a mixed inhibitory-excitatory response. From our study it clearly appears that nociceptive visceral messages only project on dorsal horn cells receiving noxious cutaneous afferents. Thus viscerosomatic convergence seems only to concern nociceptive messages; the existence of this kind of convergence reinforces the hypothesis suggested by several authors to explain referred pain from a neurophysiological point of view.

Acetylcholine↗

PubMed1984

Somato-visceral convergence in cat dorsal root ganglion neurones demonstrated by double-labelling with fluorescent tracers.

We have investigated the possibility of somato-visceral convergence in thoracic sensory dorsal root ganglia (DRG) of cats, using the technique of double-labelling with fluorescent tracers. Combinations of propidium iodide (PI) and Fast Blue (FB) or bisbenzimide (Bb) were found to be the most appropriate. FB or Bb were injected into the splanchnic nerve, and PI into the intercostal nerves. The 9th-11th thoracic cord segments and ganglia were removed after perfusal and frozen sections cut. Single- and double-labelled neurones were observed in the DRG and single-labelled neurones only in the ventral horn (PI) and lateral horn (FB, Bb) of the thoracic spinal cord. The double-labelled neurones accounted for approximately 1% of all labelled neurones, although this may be an underestimate due to the techniques used to prevent migration of the tracer from labelled cells. The double-labelled neurones provide evidence for somato-visceral convergence and indicate that the pre-spinal convergence hypothesis could explain the phenomenon of referred pain.

Animals↗

PubMed1986

Illness behavior as a predictor of pain and overt behavior patterns in chronic low back pain patients.

This study examined the relationship of self-reports of illness behavior to pain ratings and overt pain behaviors in a group of chronic low back pain patients referred for pain management. Illness behavior was measured using the Pilowsky and Spence Illness Behavior Questionnaire (IBQ) and pain behavior was recorded using a standard behavioral observation method. Multivariate regression analyses revealed that scores on the IBQ were highly predictive of a variety of indices of pain and pain behavior. These results were obtained even after controlling for significant demographic and medical status variables. The findings of this study support the utility of the IBQ in the behavioral assessment of chronic pain patients.

Back Pain↗

PubMed1992

A retrospective study of patients with cluster headaches.

Referred pain in the midface and teeth is a common clinical feature of the cluster headache and cluster headache-like disorders. It is not unusual therefore for patients with cluster headaches to go to the dentist. In this report, 33 cases of cluster headache, which met the International Headache Society classification criteria, and which were seen by us during a 2-year period, are reviewed. Fourteen (42%) of 33 patients who were seen by dental practitioners and who received some form of ineffective dental or pharmacologic treatment are described here. Since almost 50% of the cluster headache patients described here received inappropriate dental treatment, it is hoped that this review and retrospective assessment will make the dental practitioner aware of this disorder and provide a broader perspective in the treatment of pain in the orofacial region. Clinical presentation, pathogenesis, and treatment of cluster headaches are discussed.

Adult↗

PubMed1991

Afferent innervation of the gallbladder in the cat, studied by the horseradish peroxidase method.

Following injection of horseradish peroxidase (HRP) into the wall of the gallbladder of cats, HRP-positive cells were found bilaterally in dorsal root ganglia T2-L3 (T2-L2, and T3-L2/L3 also observed in a few cats) and nodose ganglia. In about 33% of animals labelled cells were also distributed in cervical dorsal root ganglia C5-C7. Labelled cells were more frequently localized on the right side than the left. There was no apparent change in numbers of labelled cells in the nodose ganglion (NG) on either side following greater and lesser splanchnicotomy or section of the right phrenic nerve or removal of the celiac ganglion. After severing both the greater and lesser splanchnic nerves unilaterally, numbers of labelled afferent cells from the gallbladder in dorsal root ganglia (DRGs) significantly decreased on the ipsilateral side but there was no change in the pattern of distribution contralaterally. After section of the right phrenic nerve, labelled cells were not found in ipsilateral cervical ganglia. That some afferent fibers from the gallbladder travel via the phrenic nerves, particularly on the right side, may be a supplementary mechanism in the generation of referred pain in gallbladder disease. The splanchnic nerves are the main, but not the only pathway for afferent fibers from the gallbladder.

Afferent Pathways↗

PubMedDate not supplied

Referred otalgia.

Referred otalgia is a challenging symptom, with the burden on the physician to identify the source. Only by careful patient history and physical examination can all causes in this extensive differential diagnosis be excluded. In the absence of primary otologic pathology, referred pain from a head and neck carcinoma must be considered foremost and ruled out.

Ear↗

PubMed1985

Trigeminal afferents to cerebral arteries and forehead are not divergent axon collaterals in cat.

Horseradish peroxidase conjugated to wheat germ agglutinin (HRP-WGA), and bisbenzimide (a fluorescent dye) were used as retrograde axonal tracers to examine whether or not intracranial and extracranial trigeminal afferents represent divergent axon collaterals. HRP-WGA was applied to the proximal segment of the middle cerebral artery and bisbenzimide was injected into a branch of the ophthalmic nerve in 5 cats. Histologic examination of the ipsilateral trigeminal ganglion revealed HRP-labeled cell bodies located among clusters of cells exhibiting bisbenzimide fluorescence. Cells containing both labels were not observed. These results support the concept that divergent axon collaterals are probably not involved in the pathogenesis of referred pain during vascular headache.

Animals↗

PubMed1992

Pre-spinal convergence between thoracic and visceral nerves of the rat.

Dichotomizing sensory axons have been demonstrated in a number of species and are of significance in understanding the possible mechanisms underlying referred pain. The present study reviews work employing fluorescent dyes as tracers to demonstrate afferent dichotomization in the peripheral nervous system. Dichotomization between the intercostal and splanchnic nerves of the rat was demonstrated by means of intraneural transport of Diamidino yellow or Fast blue. Frequency of pre-spinal somato-visceral convergence averaged 2% (range 0.1-21%). Average frequency of convergence was 8.3% (range 2-23.1%) between internal and external intercostal nerves. Control experiments in which axoplasmic transport was inhibited by vinblastine ruled out the possibility of errors from non-axoplasmic transport of the markers. Thoraco-visceral pre-spinal convergence occurs in the rat and is variable in extent.

Afferent Pathways↗

PubMed2004

Comparison of coronary artery specific leukocyte-platelet conjugate formation in unstable versus stable angina pectoris.

This study evaluates transcoronary changes in neutrophil and platelet activation and conjugate formation in patients with angina pectoris secondary to coronary artery disease. We examined parameters of neutrophil and platelet activation as well as the neutrophil-platelet conjugate formation in patients who underwent diagnostic coronary angiography. Thirty-nine patients with chest pain referred for cardiac catheterization were studied (23 patients with unstable angina pectoris [UAP] and 16 with stable angina pectoris [SAP]). Before coronary angiography, blood samples were obtained simultaneously from the aortic root and coronary sinus to assess leukocyte (CD11b) and platelet (CD62P) activation and leukocyte-platelet conjugates. There was a 94% increase in CD62-expressing platelets from the aorta to the coronary sinus in patients with UAP compared with a 49% increase in patients with SAP. The percentage of neutrophil-platelet conjugates increased by 22% in patients with UAP compared with a 16% decrease in those with SAP (p <0.01). In contrast, monocyte-platelet binding across the coronary bed increased to a similar degree in both groups. This study demonstrates an increase in neutrophil-platelet conjugates across the coronary circulation in UAP, compatible with a higher activation state in both cell types.

Angina Pectoris↗

PubMed2006

Usefulness of ultrasound contrast agent to improve image quality during real-time three-dimensional stress echocardiography.

Dobutamine stress echocardiography is an accepted tool for the diagnosis of coronary artery disease. Some investigators have claimed that 3-dimensional imaging improves the diagnostic accuracy of dobutamine stress echocardiography. The purpose of the present investigation was to examine the role of contrast echocardiography in the improvement of segmental quality and interobserver agreement during stress real-time 3-dimensional echocardiography (RT3DE). The study comprised 36 consecutive patients with stable chest pain referred for routine stress testing. Three-dimensional images were acquired with an RT3DE system with an X4 matrix-array transducer. All available reconstructed 2-dimensional segments were graded as optimal, good, moderate, or poor. Wall motion was scored as normal, mild hypokinesia, severe hypokinesia, akinesia, or dyskinesia. At peak stress, 466 of the 612 segments (76%) could be analyzed during conventional RT3DE. With contrast-enhanced RT3DE, the number of available segments increased to 553 (90%). The image quality index during conventional RT3DE was 2.2, whereas with contrast-enhanced RT3DE, it was 3.1. With conventional RT3DE, 2 independent observers agreed on the diagnosis of myocardial ischemia in 85 of 108 coronary territories (79%, kappa = 0.26). With contrast-enhanced RT3DE, agreement increased to 95 of 108 coronary territories (88%, kappa = 0.59). Study agreement on myocardial ischemia was present in 26 of 36 studies (72%, kappa = 0.43) with conventional RT3DE and in 32 of 36 studies (89%, kappa = 0.77) with contrast-enhanced RT3DE. In conclusion, during stress RT3DE, contrast-enhanced imaging significantly decreases the number of poorly visualized myocardial segments and improves interobserver agreement for the diagnosis of myocardial ischemia.

Cardiotonic Agents↗

PubMed2004

Analysis of receptive fields revealed by in vivo patch-clamp recordings from dorsal horn neurons and in situ intracellular recordings from dorsal root ganglion neurons.

It has been thought that spinal dorsal horn neurons receive convergent inputs from not only somatosensory but also visceral pathways. For instance, the referred pain is presumed to be due to the convergence of sensory inputs from cardiac and shoulder receptive fields. However, precise investigation has not been made from dorsal horn neurons yet, because of difficulty in studying the pathways from those regions by means of conventional electrophysiology. The purpose of this study is to clarify the convergent inputs to single dorsal horn neurons from wide receptive fields using an in vivo patch-clamp recording technique from the superficial spinal dorsal horn and an intracellular recording from dorsal root ganglion neurons that keep physiological connections with the peripheral sites. Identified dorsal root ganglion neurons received an input from a quite small area, about 1 x 1 mm in width of the skin. In contrast, substantia gelatinosa neurons in the spinal cord received inputs from an unexpectedly wide area of the skin. Previous extracellular recordings have, however, revealed that substantia gelatinosa neurons have small receptive field. This discrepancy is probably due mainly to an availability of the in vivo patch-clamp method to analyze sub-threshold synaptic responses. In contrast, the extracellular recording technique allows us to analyze predominantly the firing frequency of neurons. Thus, the in vivo patch-clamp recordings from dorsal horn neurons and the intracellular recordings from DRG neurons will be useful for well understanding the sensory processing in the spinal cord.

Animals↗

PubMed1998

Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points.

OBJECTIVE: To review recent clinical and basic science studies on myofascial trigger points (MTrPs) to facilitate a better understanding of the mechanism of an MTrP. DATA SOURCES: English literature in the last 15 years regarding scientific investigations on MTrPs in either humans or animals. STUDY SELECTION: Research works, especially electrophysiologic studies, related to the pathophysiology of MTrP. DATA SYNTHESIS: (1) Studies on an animal model have found that a myofascial trigger spot (MTrS) in a taut band of rabbit skeletal muscle fibers is similar to a human MTrP in many aspects. (2) An MTrP or an MTrS contains multiple minute loci that are closely related to nerve fibers and motor endplates. (3) Both referred pain and local twitch response (characteristics of MTrPs) are related to the spinal cord mechanism. (4) The taut band of skeletal muscle fibers (which contains an MTrP or an MTrS in the endplate zone) is probably related to excessive release of acetylcholine in abnormal endplates. CONCLUSION: The pathogenesis of an MTrP appears to be related to integrative mechanisms in the spinal cord in response to sensitized nerve fibers associated with abnormal endplates.

Acetylcholine↗

PubMed1999

Convergence of trigeminal input with visceral and phrenic inputs on primate C1-C2 spinothalamic tract neurons.

Trigeminal, spinal and vagal afferent fibers overlap in C1-C2 segments. We hypothesized that trigeminal input from the superior sagittal sinus (SSS) can excite C1-C2 spinothalamic tract (STT) neurons receiving thoracic visceral or phrenic inputs. Effects of SSS stimulation were evenly divided among cells responding to each nerve stimulus; magnitude of responses to ipsilateral vagal input was greater in neurons excited by SSS input. Somatic fields of 80% of neurons responding to SSS stimulation included face areas innervated by the trigeminal nerve, whereas somatic fields of 89% of neurons unaffected by SSS stimulation were located only on areas innervated by cervical spinal nerves. Results are consistent with the idea that pain referred to trigeminal areas could originate in thoracic organs.

Animals↗

PubMed2000

Urolume stent placement for the treatment of postbrachytherapy bladder outlet obstruction.

OBJECTIVES: Transurethral resection (TURP) or incision of the prostate is generally not effective for treating bladder outlet obstruction after transperineal brachytherapy for prostate cancer. Furthermore, TURP could compromise full-dose effective radiation delivery to the prostate. We analyzed the efficacy of the UroLume stent in treating the urinary outflow obstruction in such patients. METHODS: Five patients who had undergone brachytherapy (3 with (192)Ir high-dose radiation and 2 with (125)I) subsequently developed one or more episodes of urinary retention 2 weeks to 4 years after treatment. The patients failed or could not tolerate alpha-blockers or clean intermittent catheterization. Three patients subsequently underwent urethral dilation/optical internal urethrotomy for strictures, and 1 patient underwent suprapubic tube placement. Following the failure of these interventions, each of these patients had a UroLume stent placement. A single UroLume stent (2 cm in 3 patients and 2.5 cm in 2 patients) was placed under local/spinal anesthesia. RESULTS: All patients were able to void spontaneously immediately after stent placement. Of the patients with previous urethral strictures, 1 remained continent and 1 had persistent incontinence. Neither of the patients with early postbrachytherapy retention developed incontinence after stent placement. The main complaints following stent placement were referred pain to the head of the penis and dysuria. Stent-related symptoms necessitated stent removal in 2 of 5 patients, 4 to 6 weeks after placement. CONCLUSIONS: The UroLume stent can be used as an alternative form of therapy for managing postbrachytherapy bladder outlet obstruction. The treatment is easily reversible by removing the stent when obstruction resolves.

Aged↗

PubMed2003

Noxious visceral inputs enhance cutaneous tactile response in rat thalamus.

The current study investigates whether visceral nociceptive inputs affect tactile processing in the thalamic ventroposterior lateral nucleus in anesthetized rats by means of extracellular single unit recordings. Twenty out of the 44 neurons had their response to tactile stimulation increased by preceding nociceptive colorectal distension (CRD), and this influence appear more potent than the opposite effect, tactile on CRD response. There was a dynamic change of tactile response along with CRD response and the background activities as a function of repeated colorectal stimulation. The abnormal neuronal discharge in response to tactile stimulation in the condition of visceral nociception could contribute to the development of referred pain and allodynia.

Action Potentials↗

PubMed1999

A blinded pilot study investigating the use of diagnostic ultrasound for detecting active myofascial trigger points.

Myofascial trigger points (MFTPs) have been cited by numerous authors as the cause of local and referred pain which arises from muscle and its surrounding fascia. At present there is no reliable objective test which is capable of determining their presence. It was the purpose of this pilot study to assess the use of diagnostic ultrasound in determining any soft tissue changes in the region of clinically identified active MFTPs. Eleven subjects with clinically identified, unilateral, active MFTPs were examined with diagnostic ultrasound at the site of the trigger point as well as the asymptomatic, contralateral side. The analysis of the results of this pilot study found no correlation between the clinical identification of active MFTPs and diagnostic ultrasound.

Adult↗