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At least 1,297 records · Page 72Linked to original sources
PubMed2000

Novel test lead designs for sacral nerve stimulation: improved passive fixation in an animal model.

PURPOSE: To evaluate the ability of two novel coiled test stimulation lead designs to reduce or eliminate undesired migration and concomitant loss or attenuation of responsiveness to sacral nerve stimulation (SNS) associated with standard percutaneous nerve evaluation (PNE) leads. MATERIALS AND METHODS: The two novel leads (Coiled Leads 1 and 2) and a standard PNE lead were inserted bilaterally in sacral foramina of female goats. At various times thereafter threshold voltage responses were measured. Prior to lead removal, distance of lead migration was evaluated by x-ray imaging and the force necessary to displace the leads measured. Thereafter, as the leads were being removed, the force necessary for removal was also measured. RESULTS: Migration was consistently either nil or minimal for both coiled leads. In contrast, migration of the standard lead occurred in all cases and was substantial in magnitude. A significant linear association was evident between the migration distance of the standard lead and the corresponding voltages needed to evoke a response. The forces necessary to displace Coiled Lead 1 and Coiled Lead 2 were both significantly higher (p <0.01) than those for the standard lead. In some cases comparatively high forces were needed for removal of Coiled Lead 1 but not Coiled Lead 2. CONCLUSIONS: Coiled lead designs appear to offer a potentially promising alternative to standard leads for PNE, allowing a wider range of patients to be correctly identified as candidates for sacral root neuromodulation. Coiled Lead 2 merits further investigation in human subjects.

Animals↗
PubMed2000

[Ischemic disease of the lower extremity and lumbar sympathectomy].

We consider lumbar sympathectomy (LSE) to be the last attempt to improve the condition of the limb. Though being aware of inconsistent opinions on LSE, we are not opponents of this method, particularly if it is carried out in a selected group of patients, that is in case of: 1) treatment of frostbites, 2) treatment of patients at an early stage of advanced ischemia whose main symptom is moderate night pain at rest, 3) desiccation of chronically moist ulcerations between the toes, 4) treatment of patients with reflex symptomatic dystrophy (causalgia), 5) Buerger's disease.

Female↗
PubMed1998

[Hoffmann reflex elicited by magnetic stimulation of S1 nerve roots in the diagnosis of diabetic radiculopathy].

OBJECTIVE: To determine the incidence of radiculopathy in diabetic patients neurophysiologically. METHODS: The H-reflexes were elicited by magnetic stimulation to S1 nerve root at the first sacral foramen (S1 H-reflex) in 40 normal subjects and 41 diabetic patients. The action potentials of the H-reflex were recorded from the soleus muscle. For comparison, a popliteal H-reflex (stimulated at popliteal fossa), and a regular distal sensory and motor conduction of the tibial nerves were simultaneously evaluated. RESULTS: A significant correlation of the peak interval of H wave and M wave (HMI) of the S1 H-reflex with body height and age was confirmed by multiple regression analysis in the normal subjects. The simultaneous regression of the HMI adjusted on age and body height produced the formula as 0.02 x (age) + 0.03 x (height) + 0.92. At 95% normal limits of the significant test, 40.2% HMI and 53.7% amplitude of H waves of the S1 H-reflex, 54.9% latency and 46.3% amplitude of H waves of the popliteal H-reflex, 40.2% SCV and 40.2% amplitude of sensory action potentials were diagnosed as abnormal. CONCLUSIONS: A high incidence rate of diabetic radiculopathy was confirmed to be comparable to that of proximal neuropathy and distal symmetrical sensory polyneuropathy. This suggests that diabetic neuropathy may be related to metabolic and/or vascular disorders.

Adult↗
PubMed2000

Meralgia paresthetica is related to degenerative pubic symphysis.

OBJECTIVE: To investigate the relationship between meralgia paresthetica, a mononeuropathy of the lateral femoral cutaneous nerve that often starts in middle age, and radiological degeneration of the pubic symphysis. METHODS: A case-control study of patients aged 40 years and older with meralgia paresthetica who underwent surgical release of the lateral femoral cutaneous nerve; cases were included only when a pelvic radiograph was available. The control group was from a population study including persons aged 55 years and older and was matched to cases (4 controls per case) for sex and age as far as possible. We checked patient records from general practice to ensure control subjects had no symptoms of meralgia paresthetica during the previous 10 years. Radiological degeneration of the pubic symphysis was defined as present when 2 of 3 independent observers noted degeneration on the radiograph. RESULTS: Mantel-Haenszel procedure (stratified for age group and radiological osteoarthritis of the hip) showed a positive relationship (p = 0.004, OR = 4.38) between radiological degenerative pubic symphysis and meralgia paresthetica. In a separate analysis limited to men we also found this positive relationship. CONCLUSION: This study confirmed a positive relationship between radiological degeneration of the pubic symphysis and meralgia paresthetica.

Female↗
PubMed2000

[Surgical treatment of middle-aged and elderly patients with chronic ischemia and distal occlusions].

Operative treatment for critical ischemia was performed on 346 elderly and senile patients. An assessment of the distal bed and outflow pathways has shown the conditions for the reconstruction of the vessels to be unfavorable in 257 (74%) patients. Femoro-proximal-popliteal shunts were made in 82 patients with good effect in 74 of them. Femoro-distal-popliteal and tibial shunts were made in 62 patients with good effect in 52. In 12 patients out of 20 with the isolated plasty of the profound femoral artery better blood flow and arrest of pains in rest were noted. Lumbar sympathectomy was performed in 142 (41%) patients, in 46 of them it was combined with continuous intraarterial infusion and in 20 patients--in combination with the rotor osteotrepanation on the femur and shin. Good results after sympathectomy were noted in 102 patients.

Age Factors↗
PubMed2000

Long-term results of sacral nerve stimulation (S3) for the treatment of neurogenic refractory urge incontinence related to detrusor hyperreflexia.

PURPOSE: We assess clinical and urodynamic results of sacral nerve stimulation for patients with neurogenic (spinal cord diseases) urge incontinence and detrusor hyperreflexia resistant to parasympatholytic drugs. MATERIALS AND METHODS: Since 1992, 9 women with a mean age of 42.6 years (range 26 to 53) were treated for refractory neurogenic urge incontinence with sacral nerve stimulation. Neurological spinal diseases included viral and vascular myelitis in 1 patient each, multiple sclerosis in 5 and traumatic spinal cord injury in 2. Mean time since neurological diagnosis was 12 years. All patients had incontinence with chronic pad use related to detrusor hyperreflexia. Intermittent self-catheterization for external detrusor-sphincter dyssynergia was used by 5 patients. Social life was impaired and these patients were candidates for bladder augmentation. A sacral (S3) lead was surgically implanted and connected to a subcutaneous neurostimulator after a positive test stimulation trial. RESULTS: Mean followup was 43.6 months (range 7 to 72). All patients had clinically significant improvement of incontinence, and 5 were completely dry. Average number of voids per day decreased from 16.1 to 8.2. Urodynamic parameters at 6 months after implant improved significantly from baseline, including maximum bladder capacity from 244 to 377 ml. and volume at first uninhibited contraction from 214 to 340 ml. Maximum detrusor pressure at first uninhibited contraction increased in 3, stabilized in 2 and decreased in 4 patients. Urodynamic results returned to baseline when stimulation was inactivated. All patients subjectively reported improved visual analog scale results by at least 75% at last followup. CONCLUSIONS: Sacral nerve stimulation can be used as a reversible treatment option for refractory urge incontinence related to detrusor hyperreflexia in select patients with spinal lesions.

Adult↗
PubMed2001

Percutaneous sacral nerve root neuromodulation for intractable interstitial cystitis.

PURPOSE: We evaluated the efficacy of percutaneous sacral nerve root neuromodulation in women with refractory interstitial cystitis. MATERIAL AND METHODS: We prospectively evaluated 15 consecutive women with a mean age of 62 years who had refractory interstitial cystitis to determine the efficacy of percutaneous stimulation of the S3 sacral roots. The mean duration of symptoms before evaluation was 5.2 years. All women fulfilled the National Institute of Arthritis, Diabetes and Digestive and Kidney Diseases criteria for the diagnosis of interstitial cystitis and were unresponsive to standard oral or intravesical therapy. The response to treatment was assessed using pain scores, urinary diary variables and quality of life surveys. RESULTS: Mean voided volume during treatment increased from 90 to 143 ml. (p <0.001). Mean daytime frequency and nocturia decreased from 20 to 11 and 6 to 2 times (p = 0.012 and 0.007, respectively). Mean bladder pain decreased from 8.9 to 2.4 points on a scale of 0 to 10 (p <0.001). As indicated by the Short Urinary Distress Inventory and SF-36 Health Survey, the quality of life parameters of social functioning, bodily pain and general health significantly improved during the stimulation period. Of the women 73% requested to proceed to complete sacral nerve root implantation. CONCLUSION: Women with intractable interstitial cystitis respond favorably to percutaneous sacral stimulation with significant improvement in pelvic pain, daytime frequency, nocturia, urgency and average voided volume. Permanent sacral implantation may be an effective treatment modality in refractory interstitial cystitis but further long-term evaluation is required.

Adult↗
PubMedDate not supplied

[Temporary sacral neuromodulation in patients with urge incontinence].

We studied the effect of temporary sacral (S3) nerve stimulation in patients with urge incontinence (UI) who were subjected to percutaneous nerve evaluation of the S3 roots as a temporary screening test during 12 days to determine response to neuromodulation. All 18 patients (14 women and 4 men) underwent S3 neuromodulation. The response was assessed by a detailed voiding diary, symptom score and objective outcome was analyzed with urodynamic studies. We noticed a decrease of the average voiding frequency, the number of leakage episodes and pads use per 24 h in 10 days of S3 neuromodulation and returning to baseline symptoms in 20 days after completing S3 neuromodulation. Cystometrograms demonstrated increased cystometric capacity and decreased frequency and amplitude of unstable contractions. Correlation between symptomatic and urodynamic effects was incomplete. Temporary S3 neuromodulation relieved symptoms in UI patients.

Adult↗
PubMed2000

[Lumbar sympathectomy in atherosclerosis obliterance of lower limb arteries and age of the patients].

In the elderly and old patients with atherosclerosis of lower limb arteries, ultrasonic dopplerography assisted study of hemodynamics in foot with use of Valsalva and corinfar tests was carried out. It is revealed that these patients retain high reaction to sympathetic influences. The obtained data were the base for use of lumbar sympathectomy in 419 patients over 65 years as an independent method of surgical treatment and in combination with reconstructive operations on major arteries. Good results were obtained in 70.1% operated patients, satisfactory results--in 22.7%. There were no significant differences in the results of lumbar sympathectomy between this age group and younger patients.

Age Factors↗
PubMedDate not supplied

[Caudal regression syndrome. Lumbo-sacral agenesis].

Retrospective analysis of six cases of caudal regression syndrome, classified in accordance with vertebral envolvement. The degree of vertebral agenesis, morphology and topography of the conus medularis, neurologic implications (motor, sensitive and autonomous) and associated malformations, of particular importance in some situations of little significant vertebral agenesis are analyzed. Associations with eventual predisponent factors are sought.

Adolescent↗