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PubMed2002

Morbidity after procurement of radial arteries in diabetic patients and the elderly undergoing coronary revascularization.

BACKGROUND: The use of radial arteries for coronary revascularization is increasing. There remain concerns regarding alteration of upper extremity function after radial artery procurement. This study evaluates the functional morbidity in higher risk patients. METHODS: Between April 1997 and September 1999, 374 patients underwent unilateral or bilateral radial artery procurement. A questionnaire was used to evaluate symptoms related to motor and sensory function and changes in appearance after radial artery harvest. RESULTS: Two hundred eighty-nine patients were successfully interviewed. The average age was 63 years. Median follow-up was 9.5 months (range, 2 to 23 months). No patient suffered limb loss. Altered gross and fine motor function, residual pain, paresthesias, numbness, pallor, swelling, and altered temperature sensation were compared among diabetic patients, patients older than 70 years, and patients without these characteristics. CONCLUSIONS: Radial artery procurement for elective coronary revascularization can be done with minimal serious morbidity in higher risk patients. The most common symptoms were numbness and paresthesia. Despite the finding of greater residual pain in diabetic patients, we do not believe the use of radial artery conduits is contraindicated in these patients.

Adult↗

PubMedDate not supplied

Current perception threshold screening for carpal tunnel syndrome.

Screening for the onset of carpal tunnel syndrome (CTS), which is associated with excess ergonomic stresses of the wrist and hand, is a major concern in occupational medicine. CTS questionnaires, physical examinations, and quantitative sensory function determination through neuroselective current perception threshold (CPT) measurements were obtained from the median digital nerves of 16 assembly line workers who were symptomatic with hand pain. Median nerve evaluations by CPT detected sensory abnormalities in 75% of the workers, and abnormalities in 50% of the workers were detected by clinical evaluations (p less than .05, df = 22). CPT abnormalities were characterized as "hypoesthetic" in 25% and hyperesthesic in 42% of the workers. The noninvasive, nonaversive CPT technique provided sensitive and easily obtained quantitative measures. Regular use of this procedure in the occupational setting may assist in preventing the development of advanced CTS for it provides early detection of median nerve abnormalities.

Carpal Tunnel Syndrome↗

PubMed1990

Somatosensory findings in postherpetic neuralgia.

Somatic sensory perception thresholds (warm, cold, hot pain, touch, pinprick, vibration, two-point discrimination), allodynia and skin temperature were assessed in the affected area of 42 patients with unilateral postherpetic neuralgia (PHN) and 20 patients who had had unilateral shingles not followed by PHN (NoPHN), and in the mirror-image area on the other side. There was no difference between the two groups for age or length of time after the acute herpes zoster infection. The PHN group showed significant changes in all sensory threshold measurements when the affected area was compared with the mirror-image area on the unaffected side, while the NoPHN group exhibited no threshold changes. Mechanical allodynia was present in 87% of the PHN group; half of the 12 patients with ophthalmic PHN showed extension of allodynia to the maxillary distribution. No differences in skin temperature were recorded between affected and unaffected regions in either group. Our findings show a deficit of sensory functions mediated by both large and small primary afferent fibres and also suggest major central involvement in the pathophysiology of the condition. If PHN does not occur following acute herpes zoster, recovery of neural functions appears to be good.

Aged↗

PubMed2003

[Functional transcranial Doppler].

Transcranial Doppler is an ultrasonic technique, which demonstrates the blood flow velocity in the intracranial arteries. Functional Transcranial Doppler (fTCD) is a method of comparing the cerebral blood flow velocities of different arteries demonstrated simultaneously in both hemispheres. The examination is performed before and after fulfilling certain motor and sensory functions and execution of cognitive tasks. The rationale behind this method is discussed as it is applied in each of those functions. It must be stressed that there is a different role of the fTCD in the anterior vs the posterior circulation systems. Whereas many studies prove good efficacy with use of middle cerebral artery and anterior cerebral artery method, the role of the vertebrobasilar system method is unclear. In addition, although visual functions can be demonstrated well by examination of the posterior cerebral arteries, only few evidences of efficacy were published concerning vertebral and basilar artery functions. However, fTCD is useful, easy to perform and presents a very cost effective method for demonstration of cerebral blood flow changes during and after completing cognitive and motor tasks. The tests can be used in healthy persons, as well as in patients with neurological diseases and during rehabilitation period.

Blood Flow Velocity↗

PubMedDate not supplied

Phenol injection into cisterna magna for relief of advanced intractable cancer pain in the faciocephalic area.

Between 1973 and 1980 a solution of phenol in glycerin into the cisterna magna was injected in 38 patients suffering from advanced intractable pain due to neoplasm of faciocephalic area. Owing to the poor neurological and general condition of our patients, surgical procedures were discarded. Patient's age ranged from 36 to 76 years and pain diffusion involved many cranial and cervical nerves. Follow-up studies after phenol injections were carried out in 22 patients: mean survival time proved to be 137 days. In 76% of cases, before neurolytic treatment, narcotics had been administered. In this series pain relief seemed to be poor in 50%, good in 34% while it was unclassifiable in the remaining 16% of the cases due to an incomplete follow-up. These last patients were likely to show favorable results. Complications arising immediately after phenol injections are described. Long lasting disabling neurological deficits were recorded in 18% of cases. Less severe complications were shown in 71% of the patients. The most frequent ones were impairment of sensory functions of the trigeminal area and reversible paresis of the 7th cranial nerve. Despite the poor general conditions, no fatal outcome was seen in our patients. No significant relationship between pain relief and sensory deficit was found. The pathophysiological mechanisms of pain suppression, induced by phenol injection in the faciocephalic area are discussed. The value of this simple technique is briefly assessed in comparison to other analgesic procedures.

Adult↗

PubMed1980

Peripheral sympathetic function in patients with a polyneuropathy.

Abnormal peripheral vasoconstrictor responses to inspiration were found in the finger tips of 11 out of 20 patients with a suspected polyneuropathy, most of whom had no clinical evidence of autonomic involvement. Among these 11 patients the neuropathy involved both motor and sensory fibers in 9, sensory fibers alone in 1, and autonomic fibers alone in another; it was accompanied by electrical changes suggestive of axonal degeneration in 9 patients, and by normal findings in 1, while the remaining patient was not investigated electrophysiologically. In addition to conventional electrophysiological tests of somatic motor and sensory function, it is suggested that peripheral vasomotor function be evaluated when patients with a polyneuropathy are being investigated, in order to identify the spectrum of nerve fibers that are involved and thereby characterize the disorder more fully.

Adolescent↗

PubMed1990

Disordered colorectal motility in intractable constipation following hysterectomy.

Colorectal and anal sphincter motility and electrophysiology were investigated in 14 women with profound constipation following hysterectomy and compared with an asymptomatic group of control subjects. Twelve patients complained of significant urinary symptoms. No differences in the motor function of the anal sphincters were detectable. The latency of the pudendoanal reflex was unchanged after hysterectomy. Proctometrograms demonstrated significantly increased rectal volumes and compliance in the hysterectomy group together with deficits of rectal sensory function. In the basal state a significant proximal-to-distal sigmoid colon motility gradient existed only in the control group. Following stimulation with Prostigmin, this gradient was enhanced in the control group but paradoxically reversed in the hysterectomized patients, thus constituting a functional obstruction. Denervation supersensitivity was demonstrable in two patients tested with carbachol provocation but not in control subjects. These findings suggest dysfunction in the autonomic innervation of the hindgut in some patients who had undergone hysterectomy, resulting in severe constipation.

Adult↗

PubMed1991

Similar neuronal alterations induced by axonal injury and learning in Aplysia.

Learning in the marine mollusk Aplysia has been associated with enhanced sensory function, expressed in mechanosensory neurons as (i) decreases in action potential threshold, accommodation, and afterhyperpolarization, and (ii) increases in action potential duration, afterdischarge, and synaptic transmission. These alterations also occur, with a delay, after sensory axons are injured under conditions in which synaptic transmission is severely reduced. The latency and specificity of injury-induced alterations indicate that induction signals are generated at the site of injury and conveyed centrally by axonal transport. Similarities in neuronal modifications support the hypothesis that some memory mechanisms evolved from mechanisms of injury-induced sensory compensation and repair.

Action Potentials↗

PubMed2004

[Studies of the effects of sibutramine hydrochloride on perinatal development and maternal function in mice].

OBJECTIVE: To detect adverse effects on the pregnant/lactating dams and on the development of the offspring following exposure to sibutramine hydrochloride of the dams from the closure of the hard palate through weaning. METHODS: Studies on the effects of this new drug on pre- and postnatal development, including maternal function of mice were conducted. The pregnant mice were randomly divided into four groups. The dose levels were 32 mg/(kg.d) (1/5 LD50), 2.83 mg/(kg.d), 0.25 mg/(kg.d) for three groups respectively, and the fourth group was for negative control. Females were administered sibutramine hydrochloride in drink water from the closure of the hard palate (pregnant 15 d) to the end of lactation. Adverse effects on pregnant mice, pre- and postnatal deaths of offspring, altered growth and development, functional deficits in offspring were assessed. Terminal examinations included: necropsy (macroscopic examination) of all adults, abnormalities, live offspring at birth, body weight at birth, pre- and postweaning survival and growth/body weight, maturation, physical development, sensory functions and reflexes and behavior. RESULTS: The increase of death (above 10%) of pregnant and lactating mice was observed in the group of 32 mg/(kg.d). No other adverse effects on the maternal animals and offspring were observed. CONCLUSION: The data of these studies on mice showed no evidence for the reproductive toxicity to pregnant mice and the developmental toxicity to offspring induced by sibutramine hydrochloride.

Animals↗

PubMed2006

[Repair of extensive gluteal-sacral defect with posterior femoral cutaneous neurovascular island flap].

OBJECTIVE: To explore the clinical value of repairing extensive gluteal-sacral defects with the posterior femoral cutaneous neurovascular island flap. METHODS: From July 2002 to May 2005, the posterior femoral cutaneous neurovascular flap was applied to repairing extensive gluteal-sacral defects in 6 patients (3 males, 3 females; aged 31-59 years). Three patients had a skin defect in the gluteal-sacral region caused by squamous cell carcinoma, 1 patient had the defect in the same region caused by malignant fibrohistiocytoma, and 2 patients had the defect caused by bedsores of grade III . The area of defects ranged from 15 cm X 8 cm to 16 cm X 10 cm. The flaps ranged in area from 15 cm x 8 cm to 18 cm x 10 cm. RESULTS: In all the 6 patients had their flaps survived well and the wounds gained the primary healing. The follow-up for 2. 5-12 months revealed that, flaps were satisfactory in their appearance, texture, and sensory functions. CONCLUSION: The repair of extensive gluteal-sacral defects with the posterior femoral cutaneous neurovascular island flap has advantages of the unchanged anatomic structures, reliable blood supply, easy dissection for extensive defects, good sensory recovery, and sacrificing no major vessels; therefore, this kind of repair is an optimal approach to repairing extensive gluteal-sacral defects.

Adult↗

PubMed1985

Sensory development in children: research in taste and olfaction.

Taste and smell are considered important influences on food selection and intake. However, the exact nature of the effects of chemical sensory function on dietary habits is still unclear. Future research concerning this interaction should facilitate the development of optimal dietary guidelines concerning the palatability of foods for children. At present, however, some broad generalizations about sensory development and food acceptance can be made. First, sweet preference appears innate, and thus addition of sweet substances is almost certain to increase the palatability of foods. Conversely, aversions to bitterness appear from a very early age, and thus bitter flavors are likely to decrease palatability. Third, saltiness may be aversive or neutral to infants, with adult patterns of salt preference not appearing until about age 2. Fourth, odors, including volatile flavors like cherry, which are perceived via the olfactory receptors, cannot be expected to have much impact on children until about age 5. Even though children can detect such odors, their likes and dislikes are attenuated. Finally, young children probably find strong or irritative sensations in the mouth, e.g., from carbonation or pepper, to be aversive.

Adult↗

PubMed1982

[Past and present medical and biological studies in Italy on microgravity].

Since 1957, Italian workers have been carrying out experiments on the physiological and pathological effects of the weightlessness encountered during space travel. Most of this work has been done at the Air Force Aviation Medicine Study and Research Centre, Rome, while other research has been conducted at the Department of Human Physiology, University of Milan. Various original devices (axis subgravitis tower, triaxial clinostats, etc.) have been devised and constructed to simulate partial and total weightlessness. They have been employed well ahead of actual space flights in investigations of the effects of weightlessness on vestibular function, sensory and muscle coordination, the position of the diaphragm and its adjacent viscera, locomotion, plant growth, rapid adaptation phenomena, etc. One experiment conducted during orbital flight was called Orbiting Frog Otolith. This investigated vestibular function under statis and dynamic conditions in the absence of weight. An Italian three-dimensional ballistocardiography experimental project will be conducted during the first Spacelab flight.

Electrocardiography↗

PubMed2003

Real-world evaluation of visual function.

Visual function declines with age in a variety of ways. It must also be kept in mind, however, that the results reported here are primarily group findings. When evaluating the performance of older persons, there is extremely wide variability, and even though average performance may decline as a function of age, many older adults maintain excellent visual function throughout their lifetimes. It is important to keep the variability of individual performance in mind to avoid ageist stereotypes. Although declines in age-related vision are well documented, it is less clear why these declines have occurred. Most recent studies have controlled for criterion differences by using forced-choice methods. These studies confirm that even after correcting for differences in threshold criteria, age-related declines persist. Many other studies have controlled for optical changes using a variety of techniques. Again, some age-related declines still exist Although it is widely believed that the neuroanatomy and physiology of the visual pathways are affected by aging, there is still relatively little understanding of how these changes impact visual function. Thus, there is a need for further studies to link potential neural mechanisms to observed changes in functional visual performance. Furthermore, there is also a possibility that there may be multiple sites of decline within a given person and that these sites of decline may vary across persons. Thus, the use of an individual-differences approach is needed to evaluate the many potential explanations for sensory decline. Finally, there is frequently a discrepancy between performance in the laboratory and real-world performance. In trying to predict the performance of real-world tasks and in designing the best environments for the elderly, sensory function should not be considered in isolation. Rather contributing factors such as cognitive ability, expectations, distractions, and other health-related and motor problems must also be considered. Traditional clinical measures of visual function, though appropriate for evaluating the presence of disease, are often inadequate in explaining everyday performance impairments. Thus, further research is needed to fully understand the complex interactions between sensory, cognitive, motor, economic, and physical factors that together determine one's level of ability or disability in everyday tasks.

Activities of Daily Living↗

PubMed2000

CNS plasticity and assessment of forelimb sensorimotor outcome in unilateral rat models of stroke, cortical ablation, parkinsonism and spinal cord injury.

We have reviewed a battery of useful tests for evaluating sensorimotor function and plasticity acutely and chronically in unilateral rat models of central nervous system injury. These tests include forelimb use for weight shifting during vertical exploration in a cylindrical enclosure, an adhesive removal test of sensory function, and forelimb placing. These tests monitor recovery of sensorimotor function independent of the extent of test experience. Data are presented for four models, including permanent focal ischemia, focal injury to the forelimb area of sensorimotor cortex, dopaminergic neurodegeneration of the nigrostriatal system, and cervical spinal cord injury. The effect of the dendrite growth promoting factor, Osteogenic Protein-1 (OP-1) on outcome following permanent middle cerebral artery (MCA) occlusion was used as an example to illustrate how the tests can be applied preclinically. OP-1 showed a beneficial effect on limb use asymmetry in the cylinder test.

Animals↗

PubMed2002

Protons at the gate: DEG/ENaC ion channels help us feel and remember.

The DEG/ENaC ion channel family contributes to channels of striking functional diversity. Neuronally expressed family members include the C. elegans degenerins that mediate touch and are thought to be mechanically gated, and the mammalian ASICs, which are gated by protons. ASICs affect a range of sensory functions that includes perception of gentle touch, harsh touch, heat, sour taste, and pain. Family member ASIC1 is now implicated in long-term potentiation, suggesting that minute fluxes in synaptic pH may activate ASICs to enhance learning.

Animals↗

PubMed2005

Does radial artery harvesting for coronary revascularization cause neurological injury in the forearm and hand?

OBJECTIVE: Radial artery (RA) is now used widely as a conduit of choice in coronary artery bypass grafting. Although RA removal is considered safe in the presence of adequate collateral arterial supply, there is still a considerable suspicion on the functional status of the forearm and hand. However, a neurological dysfunction may occur owing to either surgical trauma or ischemic neuropathy. This study was aimed to investigate the functional outcome of the donor forearm nerves of the patients who underwent coronary artery bypass grafting surgery with RA conduits. METHODS: A consecutive series of 50 patients who underwent coronary artery bypass graft surgery with one or two RA grafts were investigated in the study. Motor and sensory functions of donor forearm nerves were measured by ENMG studies, pre- and postoperatively at the third week and sixth month of the operation. The conduction velocities, distal latencies and amplitudes of action potentials for motor and sensorial conductions of radial, ulnar and median nerves were measured in each ENMG examination. Neurologic status of the donor forearm and hand was assessed by the same neurologist who performed a detailed neurologic physical examination and ENMG studies. Results were statistically compared using one-way ANOVA test. RESULTS: The incidence of any neurologic symptoms was 32% in early postoperative period. All reported neurologic complaints were associated with sensory conduction deceleration in ENMG investigations of related nerves. In postoperative assessment, median nerve sensory-motor, and ulnar nerve motor conduction records were slightly lower than the preoperative values, but no statistical difference was observed. Pre- and postoperative radial nerve motor and sensory conduction records were statistically similar (P>0.05). CONCLUSIONS: We advocate that removal of RA does not lead to any major neurologic hand complications in the presence of adequate collateral arterial blood supply. ENMG studies confirmed minimal conduction alterations with no statistical significance, even if neurologic symptoms were stated.

Action Potentials↗

PubMed1997

Somatosensory evoked potentials in adults with cortical dysgenesis and epilepsy.

Cortical dysgenesis (CD) is a well-recognised cause of epilepsy, but its functional anatomy is not fully understood. We recorded cortical somatosensory evoked potentials (SEPs) in 13 adult patients with epilepsy and various CDs excluding diffuse gyral malformations as diagnosed by MRI. The CD involved the perirolandic/perisylvian region in 7 patients. Six patients had neurological signs but only 3 had sensory dysfunction (astereognosis). As compared with 12 control subjects, SEPs were considered definitely abnormal in 7 patients (including the 6 with neurological signs) and equivocally abnormal in 2. The abnormalities ranged from defects affecting single components to absence of all potentials of cortical origin in one patient with hemiparesis and astereognosis. In this case it appears that gross sensory function must have been mediated by subcortical structures or through diffuse cortical projections. The initial cortical potentials (N20/P20) were absent in 6 patients, 5 of whom had CD in zones involving or bordering on the primary sensory cortex. Parietal potentials following N20 were absent or attenuated in 4 patients and of abnormally wide distribution, spreading to frontal, midline and ipsilateral electrodes, in 3 frontal components following P20 were absent, attenuated, delayed or distorted by abnormal spread of the parietal activity in 5 patients. Five patients with unilateral CD showed definite or equivocal SEP abnormalities to stimulation of both arms, suggesting there may be more widespread disturbance of cortical organisation and/or synaptogenesis, beyond the resolution of present day neuroimaging.

Adolescent↗

PubMed1996

Preliminary study of low-level laser for treatment of long-standing sensory aberrations in the inferior alveolar nerve.

PURPOSE: The incidence of inferior alveolar nerve (IAN) damage during removal of third molar teeth has been reported to be as high as 5.5% and up to 100% during sagittal split osteotomy. Sensory aberrations in the IAN persisting for longer than 6 months leave some degree of permanent disability. The purpose of this double-blind, clinical trial was to examine the effects of low-level laser (LLL) treatment using a GaAIAs laser (820 nm, Rønvig, Denmark) on touch and temperature sensory perception after a long-standing postsurgical IAN injury. PATIENTS AND METHODS: Thirteen patients were divided into two groups, one of which received real LLL (4 x 6 J per treatment along the distribution of the IAN to a total of 20 treatments) and the other placebo LLL. The degree of mechanoreceptor injury as assessed by Semmes Weinstein Monofilaments (North Coast Medical, San Jose, CA) were comparable in the two groups before treatment. The degree of thermal sensitivity disability as assessed using a Thermotester (Somedic AB, Stockholm, Sweden) to examine the indifferent temperature threshold was also comparable between the two groups before LLL. RESULTS: Subsequent to LLL, the real laser-treated group showed a significant improvement in mechanoreceptor sensory testing (P = .01) compared with the placebo group, as manifested by a decrease in load threshold (g) necessary to elicit a response from the most damaged area. In addition, the real LLL group reported a subjective improvement in sensory function. There was no significant improvement in thermal sensitivity post-LLL for either the real or placebo laser-treated groups. CONCLUSION: It was concluded that LLL can improve mechanoreceptor perception in long-standing sensory aberrations in the IAN.

Adolescent↗