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At least 1,297 records · Page 72Linked to original sources
PubMed2001

The effect of intrathecal analgesia on the success of external cephalic version.

UNLABELLED: External cephalic version (ECV), the procedure whereby a fetus in the breech position is converted to vertex, is often performed to avoid an operative delivery. Potential benefits of epidural and spinal anesthesia for this procedure are controversial. Several previous studies have evaluated the use of epidural anesthesia with varying results. We sought to determine whether analgesia produced by subarachnoid sufentanil would safely improve the success of ECV. Patients who received subarachnoid analgesia (n = 20) were compared with those who did not (n = 15) in regard to success of ECV, level of pain during ECV, and satisfaction. ECV was successful in 21 patients (60%), with more frequent success in women who received spinal analgesia as compared with those who did not (80% vs 33%, respectively; P = 0.005). Patients who received spinals also reported smaller pain scores and were more satisfied with ECV. None of the women who received spinal analgesia developed a postdural puncture headache, and the only case of fetal bradycardia occurred in a patient who did not receive spinal analgesia. More profound patient comfort after spinal analgesia may have permitted greater manipulation of the abdomen during ECV, thus improving success rates of ECV without increasing risk. IMPLICATIONS: The success of external cephalic version (ECV) was compared in women who received spinal analgesia and those who did not. Successful ECV occurred more frequently in those women who received spinal analgesia. Because term singleton pregnancies associated with breech position usually require cesarean delivery, an increase in success of ECV may decrease the number of cesarean deliveries performed.

Adult↗
PubMed1986

Enhancement by serotonin of tonic vibration and stretch reflexes in the decerebrate cat.

The effects of pharmacological manipulation of serotonergic systems on spinal reflexes were determined in the unanesthetized decerebrate cat. The prolonged motor output that continues after cessation of high frequency longitudinal tendon vibration was strongly enhanced by the serotonin reuptake blocker fluoxetine and the serotonin precursor 5-hydroxytryptophan, and was decreased by the serotonin receptor antagonist methysergide. In addition, both dynamic and static stretch reflex stiffness was markedly increased by fluoxetine and 5-hydroxytryptophan, while methysergide produced a decrease in stretch reflex stiffness. These powerful effects on tonic vibration and stretch reflexes could not be explained by drug-induced alterations in muscle spindle primary afferent discharge. In light of other recent results on serotonin-mediated effects on motoneurons, we believe that the effects of these agents result from modification of an intrinsically mediated prolonged depolarization of spinal neurons. However, the possibility that these drugs modify longlasting discharge in associated interneuronal pathways cannot be ruled out.

Animals↗
PubMed2006

Reflex gain of muscle spindle pathways during fatigue.

There are conflicting observations of the effects of fatigue on the sensitivity of large diameter Ia afferents. Our goal was to characterize any fatigue-related changes in the spinal reflex pathways during fatigue. Manipulation of the Ia afferent response by vibration and tendon tap, in which the motor neuron pool is modulated by both short- and long-loop activation from muscle spindles, were elicited before and after a fatigue task. The fatigue task consisted of intermittent submaximal and maximal voluntary contractions (MVCs). Percent voluntary activation fell from 98.75% MVC to 80.92% MVC following the fatigue task as measured by the twitch interpolation technique. Voluntary contractions of the same force profile as the force produced by 30 s of vibration were produced by having participants (n = 10) follow the trajectory on a computer monitor, before and after the fatigue task. Recruitment thresholds (RTs) of voluntarily activated units showed no change during fatigue; however, units activated via the reflex pathway were recruited approximately 30% sooner during fatigue (P < 0.05). The ratio of the electrical-to-mechanical response of the tendon tap increased significantly with fatigue. Our findings of decreased RTs in response to vibration and increased EMG activity during the tendon tap following the fatigue task indicate that Ia afferent input to the motoneuron pool was increased. The decrease in MVC force indicates that during this time the descending drive was compromised. These results provide evidence that the gain of the gamma loop is increased during fatigue, indicating possible peripheral neural compensation to the motor neuron pool in order to preserve force output.

Action Potentials↗
PubMed2000

[Peroperative erection in lower urologic surgery].

Erection is a rare event during lower urinary tract surgery. When it is extremely refractory, endoscopy is impossible and the lower urinary tract surgery may need to be deferred. The development of erection during spinal anaesthesia is due to manipulations before complete installation of sensory block or incomplete blockade of sacral segments (S2 to S4) supplying the nervi erigentes. The mechanism of erection during general anaesthesia remains poorly elucidated. General anaesthesia may suppress central or peripheral sympathetic control of flaccidity. The peripheral target could be the smooth muscle of the cavernous tissue, either by a direct action or via alpha-adrenergic receptors. Psychogenic and reflexogenic stimuli have also been proposed, possibly facilitated by amplification of sensations during stage II anaesthesia. The various treatments are based on experience acquired in the field of priapism. Systemic treatments such as ketamine an beta 2 mimetics or benzodiazepines are not always effective and are associated with considerable adverse effects. Intracavernous injections of alpha-adrenergic drugs constitute the treatment of choice. Phenylephrine and etilefrine are preferred because of their rapid efficacy and particularly their only moderate cardiovascular adverse effects.

Anesthesia↗
PubMed2002

[Meniscoids of the intervertebral joints].

PURPOSE OF THE STUDY: A large amount of material was used to study the distribution, location and shape of meniscoids in intervertebral joints of the human spine, from the atlanto-occipital joint to the sacrum, in order to find out how many of intervertebral joints had mobile meniscoids. These might be regarded as possible causes of spinal blockade or other vertebrogenous complaints. MATERIAL: The materials provided by the Department of Anatomy and Department of Forensic Medicine at the Faculty of Medicine of Charles University in Pilznen included 20 cadaverous spines from humans aged 20 to 80 years. METHODS: Access to each joint was provided by dissection of the articular capsule from the lower articular processes of the vertebra situated above. In the orthograde view, all meniscoids were described in terms of shape, size, consistence and location. Their structure was ascertained by histological examination of cross sections stained with haematoxylin and eosin. RESULTS: Meniscoids varying in shape and size were found in all of the intervertebral joints. They were classified by their histological structure as synovial, fat and fibrous meniscoids. The first category was observed frequently, the last only rarely. A total of 29 mobile meniscoids were recorded, most of them in the lumbar spine. Most of the meniscoids present in the cervical spine were of synovial and less frequently of fat types. Meniscoids found in the thoracic spine were poorly developed synovial ones and those present in the lumbar spine were of all types and were also largest in size. The most conspicuous meniscoids were seen in the spines that showed degenerative changes in intervertebral joints. Large fat pads were found in atlanto-occipital and atlanto-axial joints. Mobile meniscoids, most of them present in the lumbar spine (6.4% of all joints.), were connected with the capsule by a thin pedicle and it was possible to move them over a half of the articular surface. Some inter-individual changes were also found; in some spines, the most developed meniscoids were fat pads, in the others, these were synovial meniscoids. Spines of younger individuals showed a predominance of synovial meniscoids with smooth surfaces that arched against the articular cavity. In spines of elderly individuals, meniscoids were rough, in some cases fibrous in structure, and had a lobulated or frayed edge. DISCUSSION: The shape, location of meniscoids and their presence in every joint indicate their definite role for the spine: they compensate the incongruence of articular surfaces, fill in empty spaces and facilitate spread of synovial fluid during translation movements. Variability in shape, size and location of meniscoids give support to the view that meniscoids developed secondarily in relation to the morphogenesis of articular surfaces and that they are fully adapted to the shape and function of the joint. Mobile meniscoids, particularly fibrous ones, can get wedged between articular surfaces due to a sudden, rush movement (entrapment theory) or can be caught between the edge of an articular surface and the articular capsule attachment (extrapment theory). This situation may result in either mechanical or functional blockade of the spine and a subsequent painful condition due to compression of nerves and reflex contraction of muscles. Direct evidence of such blockade and the validity of either hypothesis can today be provided by magnetic resonance imaging. CONCLUSIONS: All intervertebral joints, along the length of spine, possess capsule processes, i.e., meniscoids, which can be classified as synovial, fat and fibrous. Meniscoids are most developed in the lumbar and cervical spine. They serve to compensate for the incongruence of articular surfaces and to fill in empty spaces. Mobile, peduncular meniscoids can, at sudden or non-physiological movements, be caught between articular surfaces and cause spinal blockade and painful conditions. Manipulative treatment is, therefore, justified in indicated cases.

Adult↗
PubMedDate not supplied

Resolution of spasmodic dysphonia (focal laryngeal dystonia) via chiropractic manipulative management.

This paper discusses the case of a 46-yr-old male suffering from spasmodic dysphonia, a chronic disorder involving hyperadduction of the vocal mechanism and resultant vocal arrest. Attention is paid to the neural innervation of the intrinsic laryngeal musculature and postulated mechanisms of irritation which may be amenable to chiropractic manipulative therapy. The type of spinal adjustment and treatment schedule are discussed.

Chiropractic↗
PubMed1992

Pharmacologic strategies in the treatment of experimental spinal cord injury.

Remarkable advances have been made in pharmacologic treatments of acute and chronic spinal cord injury. The recent National Acute Spinal Cord Injury Study (NASCIS) showed that very high dose methylprednisolone given within 8 hr after injury improves neurologic recovery. The mechanism is believed to be inhibition of lipid peroxidation. Many other drugs have been claimed to be beneficial in animal studies, including other lipid peroxidation inhibitors, free radical scavengers, opiate receptor blockers, NMDA receptor blockers, calcium channel blockers, inhibitors of arachidonic acid metabolism, and protease inhibitors. In chronic spinal cord injury, much progress also has been made. Myelin was found to possess factors that inhibit axonal regeneration. Blocking these factors enhances spinal cord regeneration. Monosialic gangliosides (GM1) were recently found to improve neurologic recovery in spinal-cord-injured patients. Given as late as 48-72 hr after injury, the mechanism of action is not well understood. However, the GM1 results give hope that recovery mechanisms can be manipulated pharmacologically. Nonregenerative therapy for chronic spinal cord injury is also being developed. Several drugs, including 4-aminopyridine and baclofen, respectively blockers of potassium channels and GABA-B receptors, improve conduction in demyelinated axons. These drugs may be useful for identifying patients who might benefit from remyelination therapy. Finally, NASCIS has complicated acute spinal cord injury studies. To bring a drug to clinical trial, an investigator must now determine the optimal treatment dose, timing, and duration over a range of injury severities, in comparison and combination with methylprednisolone. This requirement has so increased the scale of drug testing that multicenter laboratory trials may be necessary.

4-Aminopyridine↗
PubMed1997

Technique of video-assisted thoracoscopic surgery for the spine: new approach.

Although video-assisted thoracoscopy has only recently been applied to treat a variety of thoracic spine lesions, many problems and difficulties are encountered with this technique owing to limited trocar space and lack of suitable endoscopic instruments. Between November 1995 and March 1996, we practiced a new approach for video-assisted thoracoscopic surgery, the "extended manipulating channel method," for treating 18 patients with thoracic spinal lesions endoscopically. The thoracoscopic portals were made larger (usually 3-4 cm) and placed slightly more posterior than usual, which allows use of a combination of conventional spinal instruments and video-assisted thoracoscopy to enter the chest cavity and be manipulated similar to that with techniques used for standard open surgical procedures. In our series the endoscopic spinal procedures included biopsy only (n = 1), thoracic discectomy (n = 1), multilevel anterior discectomy and fusion (n = 1), corpectomy for decompression (n = 4), decompressions and interbody fusions (n = 10), and internal instrumentations (n = 4). Throughout the operation only one trocar was used for introducing the thoracoscope. There were no intraoperative deaths, and no patients showed neurologic deterioration due to the procedures. We conclude that such a technique makes thoracoscopy-assisted spinal surgery simpler and easier and has proved to be an effective, promising procedure. It does not appear to compromise the therapeutic goals set for the patients. The intraoperative vessel bleeding can be easily controlled, and the number of portals for the procedures can be reduced (on average, three portals are enough). Few endoscopic materials were used with our patients, and thus the total economic cost to the patients was reduced.

Adolescent↗
PubMed2001

Schwannoma: challenging diagnosis.

OBJECTIVE: To discuss the presentation of a schwannoma in a 30-year-old man and to discuss the clincial features of this tumor. CLINICAL FEATURES: The patient had lower right back and abdominal pain that was made worse by any jarring motion. Magnetic resonance imaging showed an intradural extramedullary mass of the thoracic spine behind the T10 vertebral body, which was found to be a schwannoma. INTERVENTION AND OUTCOME: A full laminectomy of T10 and partial laminectomies of T9 and T11 allowed removal of the tumor. CONCLUSION: When undiagnosed abdominal pain is present, spinal tumor should be considered one possible diagnosis.

Abdominal Pain↗
PubMed1999

Possible manifestation of temporomandibular joint dysfunction on chiropractic cervical X-ray studies.

OBJECTIVE: Our purpose was to show that biomechanical alterations toward and away from normal on x-ray studies may be the result of changes in temporomandibular joint dysfunction and to discuss possible neurologic explanations for this phenomenon. CLINICAL FEATURES: Two patients are discussed; the first had migraine headache symptoms, and the second had chronic hypomobility of mandibular opening, dizziness, headache, and neck pain and stiffness. In both patients mensuration changes in different types of cervical x-ray studies were noted in conjunction with exacerbation of, and elimination of, temporomandibular joint dysfunction. INTERVENTION: Comanagement of these cases was done with dental professionals. Chiropractic treatment included vectored/linear, upper cervical, high-velocity, low-amplitude chiropractic manipulation of the atlas vertebra, diversified manipulation, myofascial therapy, stretch and spray procedures, and soft tissue manual techniques. CONCLUSION: Temporomandibular joint dysfunction may cause cervical muscular and spinal biomechanical changes that may become visible and change on x-ray examination. Further investigation into this phenomenon is recommended.

Biomechanical Phenomena↗
PubMedDate not supplied

[Imaging of blocks in the spine with bone scintigraphy (SPECT)].

INTRODUCTION: One of the most important tasks of manual therapists is the treatment of hypomobile intervertebral joints. Such conditions of the spine are treated with various manipulations or mobilisation. The pathophysiological basis of hypomobility is still under discussion. Objective criteria for the diagnosis of impaired spinal mobility are not available. Nor is any substrate detectable by X-ray, computed tomography or NMR. AIM: To find evidence of a biomechanical alteration of hypomobile intervertebral joints with the aid of SPECT (Single Photon Emission Computed Tomography). STUDY DESIGN: 13 outpatients with back pain but otherwise healthy attending the Orthopaedic University Hospital in Marburg were examined by manual medical means, and were found to have hypomobility of an intervertebral joint. In addition, the spines of these patients were examined with SPECT (bone scanning). RESULTS: Comparison of the results of physical examination and bone scanning revealed that in 75% of all the cases the location (spinal segment) of the hypomobility identified by each of the two methods was identical. In 83%, they were in agreement on which of the sides (facet joint) was affected.

Adolescent↗
PubMed1994

Illness-induced hyperalgesia is mediated by a spinal NMDA-nitric oxide cascade.

A variety of experimental manipulations produce enhanced pain responsivity. Recent work has demonstrated that activation of N-methyl-D-aspartate (NMDA) receptors in the spinal cord can produce persistent enhancement of pain via production of nitric oxide and/or prostaglandins. To date, the behavioral paradigms used to study NMDA mediated hyperalgesia have all involved direct excitation of spinal cord dorsal horn neurons via activation of primary nociceptive afferents. The present series of experiments examined whether the NMDA cascade would also be activated by events that do not produce direct pain input to the spinal cord dorsal horn. The hyperalgesia-inducing paradigm used was intraperitoneal lipopolysaccharide (LPS), which causes transient illness. Prior work has shown that LPS induces hyperalgesia via activation of hepatic vagal afferents to the brain, thereby activating a centrifugal pain facilitory circuit. The present study demonstrates that this centrifugal hyperalgesia is produced via activation of the NMDA-nitric oxide cascade at the level of the spinal cord.

2-Amino-5-phosphonovalerate↗
PubMed2002

Development and characterization of a novel, graded model of clip compressive spinal cord injury in the mouse: Part 1. Clip design, behavioral outcomes, and histopathology.

In order to take advantage of various genetically manipulated mice available to study the pathophysiology of spinal cord injury (SCI), we adapted an extradural clip compression injury model to the mouse (FEJOTA mouse clip). The dimensions of the modified aneurysm clip blades were customized for application to the mouse spinal cord. Three clips with different springs were made to produce differing magnitudes of closing force (3, 8, and 24 g). The clips were calibrated regularly to ensure that the closing force remained constant. The surgical procedure involved a laminectomy at T3 and T4, followed by extradural application of the clip at this level for 1 min to produce SCI. Three injury severities (3, 8, and 24 g), sham (passage of dissector extradurally at T3-4), and transection control groups were examined (n = 12/group). Quantitative behavioural assessments using the Basso, Beattie, and Bresnahan (BBB; H > 46; df = 4; p < 0.001; Kruskal-Wallis one-way ANOVA) and inclined plane (IP; F = 123; df = 4; p < 0.0001; two-way repeated measures ANOVA) tests showed a significant graded increase in neurological deficits with increasing severity of injury. By day 14, the motor recovery of the mice plateaued. Qualitative examination of the injury site morphology indicated that microcystic cavitation, degenerating axons, and robust astrogliosis were characteristic of the murine response to clip compressive SCI. Morphometric analyses of H&E/Luxol Fast Blue stained sections at every 50 microm from the injury epicenter indicated that with greater injury severity there was a progressive decrease in residual tissue (F = 220, df = 3; p < 0.0001; two-way ANOVA). In addition, statistically significant differences were found in the amount of residual tissue at the injury epicenter between all of the injury severities (p < 0.05, SNK test). This novel, graded compressive model of SCI will facilitate future studies of the pathological mechanisms of SCI using transgenic and knockout murine systems.

Animals↗
PubMed2005

Distraction manipulation of the lumbar spine: a review of the literature.

OBJECTIVE: The purpose of this study is to review the literature concerning distraction manipulation of the lumbar spine, particularly regarding physiological effects, clinical efficacy, and safety. DATA SOURCES: A search of the English language literature was conducted using the MEDLINE, Embase, CINAHL, Chiropractic Research Archives Collection, and Manual, Alternative, and Natural Therapies Information System databases. A secondary hand search of bibliographies was completed to identify older or nonindexed literature. DATA SELECTION AND EXTRACTION: Articles were identified, which described the characteristics of distraction manipulation beyond a simple description or the results of treatment with distraction manipulation. Data were extracted on the basis of relevance to the stated objective. DATA SYNTHESIS AND RESULTS: Thirty articles were identified. Three were uncontrolled or pilot studies, 3 were basic science studies, and 6 were case series. Most were case reports. Lumbar distraction manipulation is a nonthrust mechanically assisted manual medicine technique with characteristics of manipulation, mobilization, and traction. It is used for a variety of lumbar conditions and chronic pelvic pain. The primary rationale for its use is on the basis of the biomechanical effects of axial spinal distraction. Little data are available describing the in vivo effect of distraction when used in combination with flexion or other motions. CONCLUSIONS: Despite widespread use, the efficacy of distraction manipulation is not well established. Further research is needed to establish the efficacy and safety of distraction manipulation and to explore biomechanical, neurological, and biochemical events that may be altered by this treatment.

Biomechanical Phenomena↗
PubMed2003

Postoperative ileus is maintained by intestinal immune infiltrates that activate inhibitory neural pathways in mice.

BACKGROUND AND AIMS: Postoperative ileus after abdominal surgery largely contributes to patient morbidity and prolongs hospitalization. We aimed to study its pathophysiology in a murine model by determining gastric emptying after manipulation of the small intestine. METHODS: Gastric emptying was determined at 6, 12, 24, and 48 hours after abdominal surgery by using scintigraphic imaging. Intestinal or gastric inflammation was assessed by immune-histochemical staining and measurement of tissue myeloperoxidase activity. Neuromuscular function of gastric and intestinal muscle strips was determined in organ baths. RESULTS: Intestinal manipulation resulted in delayed gastric emptying up to 48 hours after surgery; gastric half-emptying time 24 hours after surgery increased from 16.0 +/- 4.4 minutes after control laparotomy to 35.6 +/- 5.4 minutes after intestinal manipulation. The sustained delay in gastric emptying was associated with the appearance of leukocyte infiltrates in the muscularis of the manipulated intestine, but not in untouched stomach or colon. The delay in postoperative gastric emptying was prevented by inhibition of intestinal leukocyte recruitment. In addition, postoperative neural blockade with hexamethonium (1 mg/kg intraperitoneally) or guanethidine (50 mg/kg intraperitoneally) normalized gastric emptying without affecting small-intestinal transit. The appearance of intestinal infiltrates after intestinal manipulation was associated with increased c-fos protein expression in sensory neurons in the lumbar spinal cord. CONCLUSIONS: Sustained postoperative gastroparesis after intestinal manipulation is mediated by an inhibitory enterogastric neural pathway that is triggered by inflammatory infiltrates recruited to the intestinal muscularis. These findings show new targets to shorten the duration of postoperative ileus pharmacologically.

Animals↗
PubMed1998

Paraspinal muscle abscess after Chinese Kong Fu practitioner manipulation--a case report.

Paraspinal infection is a rare condition. Modes of infection include transcutaneous infection of the deep tissue by needles or catheters, surgery, blunt trauma, and hematogenous spread from distant sites. Chiropractic manipulation is a noninvasive procedure but is sometimes associated with vascular or neurologic insults resulting in hematoma or cerebrovascular accidents. We report a paraspinal muscle abscess in a healthy young man 7 days after Chinese Kong Fu practitioner manipulation for back pain without definite infection sources. The local paraspinal tenderness as demonstrated by the patient should be considered to be a sign of infection. Paraspinal infection often subjects to delayed diagnosis and this delay may be disastrous. In the management of low back pain or treating spinal disorders, physicians should be aware of the possibility of such a condition particularly in patients whose back pain has been managed with chiropractic manipulation to avoid misdiagnosis.

Abscess↗