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PubMed1996

Tactile perception of spatial stimuli on the lip surface by young and older adults.

Although older adults are subject to both subtle changes and major disorders of the oral sensorimotor system, relatively little is known about oral sensory function in old age. Accurate assessment of oral tactile perception is needed to document disability, aid prognosis, and plan treatment for older adults with disorders affecting speech or feeding. However, normative information currently available for older adults is mainly based on two-point discrimination, a problematic measure of tactile spatial resolution. Grating orientation discrimination, a technique developed to provide a clear and reliable measure of spatial resolution, was used to test sensitivity of the upper and lower lip vermillion, on right and left sides, in a sample of 40 young adults and 40 adults age 66-85. Results indicated that spatial acuity at the lip vermilion declines significantly in old age and that women tend to have better acuity than men. No significant differences were found in acuity between the upper and lower lips or between right and left sides for either age group. Peripheral changes in receptor density and lip tissue composition are suggested as likely causes for the age-related decline.

Adolescent↗

PubMed1997

Review article: irritable bowel syndrome.

Irritable bowel syndrome is a disease that can be diagnosed positively on the basis of an established series of criteria and limited exclusion of organic disease. It is the most common disease diagnosed by gastroenterologists and affects about 20% of all people at any one time. Symptoms fluctuate, and the overall prevalence rate is relatively constant in Western communities. Ten per cent of patients present to their physicians; the illness has a large economic impact on health-care utilization and absenteeism. Irritable bowel syndrome is a biopsychosocial disorder in which three major mechanisms interact: psychosocial factors; altered motility; and/or sensory function of the intestine. Management of patients is based on positive diagnosis of the symptom complex, limited exclusion of underlying organic disease and institution of a therapeutic trial. If patient symptoms are intractable, further investigations are needed to exclude significant motility or other disorders. Symptomatic treatment includes fibre for constipation, loperamide for diarrhoea and low-dose antidepressants or infrequent use of antispasmodics for pain; novel pharmacological agents, psychotherapy and hypnotherapy are being evaluated.

Colonic Diseases, Functional↗

PubMed2001

Sensory impairments, intellectual disability and psychiatry.

The present review looks at: (1) prevalence studies of sensory impairments in people with intellectual disability (ID); (2) studies looking at psychological and psychiatric disorders in people with sensory impairments; and (3) studies that have examined the association of sensory impairments with autism. Research has indicated that sensory impairments are more common in people with ID. Psychiatric disorders are believed to be more common in children with visual impairment (VI) when associated with other handicaps. Some authors believe that hearing impairment (HI) can result in personality disorders. Studies have also shown a higher prevalence of psychiatric disorders in children with HI and a higher incidence of deaf people in psychiatric hospitals than in the general population. Psychiatric disorders in children with HI are particularly associated with low IQ and low communication ability, especially in those with multiple handicaps. There is little evidence for a higher incidence of schizophrenia in people with HI. Blind people demonstrate many autistic-like features and there has been discussion in the literature as to their cause. Deaf people also demonstrate some similar features to those in autism, but an association with autism has not been conclusively made. Deaf-blind people commonly demonstrate problem behaviour (e.g. self-injury). Usher syndrome, which is the most common cause of deaf-blindness, is associated with psychiatric disorders, particularly psychosis. The need for assessment of sensory functioning in people with ID, the difficulties inherent in this and the need for specialist services is stressed.

Autistic Disorder↗

PubMed2003

Selective increase of tumour necrosis factor-alpha in injured and spared myelinated primary afferents after chronic constrictive injury of rat sciatic nerve.

Chronic constriction of the sciatic nerve, leading to a hyperalgesic state, results in a partial lesion wherein some axons are injured and others remain intact. Here we sought to characterize reactive changes which occur in DRG cell bodies of injured and uninjured axons projecting to skin and muscle. Using immunohistochemistry combined with flurorogold and fluororuby retrograde labelling to define DRG cell bodies associated with injured and uninjured axons, we analysed the DRG immunoreactivity (IR) for tumour necrosis factor-alpha (TNF), interleukin-10 (IL-10), the sensory neuron-specific channel vanilloid receptor 1 (VR1), isolectin B4 (IB4) and calcitonin-gene-related peptide (CGRP) 4 days after a unilateral chronic constriction injury (CCI) of the rat sciatic nerve. TNF IR was predominantly localized in neuronal DRG cells. In DRG with an intact nerve, TNF IR was present in 45%, IL-10 IR in 46%, VR1 IR in 44%, IB4 IR in 51% and CGRP IR in 40% of all neuronal profiles. Four days after CCI, TNF IR was increased in medium-sized neurons, whereas IR for IL-10, VR1 and IB4, predominantly present in small neurons, was reduced. Importantly, not only injured but also adjacent spared neurons contributed markedly to increased TNF IR. Neurons projecting to both muscle and skin displayed upregulated TNF IR after CCI. TNF in medium-sized neurons colocalized with neurofilament and trkB, but not with IB4, trkA or RET, suggesting a selective phenotypic switch in presumably low-threshold myelinated primary afferents. Spared myelinated fibres with intact sensory functions but upregulated TNF expression may contribute to behavioural changes observed after nerve injury.

Animals↗

PubMed1999

Motor fluctuations in Parkinson's disease: pathophysiology and treatment.

At the initial stages of Parkinson's disease (PD), levodopa (LD) is able to reduce most motor symptoms and to significantly improve the patient's quality of life. However, in the vast majority of patients with prolonged LD usage, some decline in efficacy occurs and motor complications eventually begin to appear. These complications consist not only of daily fluctuations in the voluntary motor performance often accompanied by involuntary movements, but also of fluctuations in cognitive, autonomic, and sensory functions. Several recent studies on LD complications in PD have led to a better understanding of their pathophysiology and of the possible therapeutic interventions, and a summary of these findings is presented in this review. Different observations now suggest that postsynaptic pharmacodynamic factors play a major role in determining fluctuations in PD. Two explanations are given: chronic intermittent dopaminergic therapy may lead to postsynaptic receptor downregulation in PD; or, receptor changes in the striatum may occur independently of treatment as a result of structural adaptation of the postsynaptic dopaminergic system to the progressive decline of the nigrostriatal pathway. The hypothesis of reversible postsynaptic changes as the main mechanism underlying a fluctuating response to LD lends itself to a possible pharmacological manipulation of the dopaminergic response to reverse, or even avoid, motor fluctuations (initial monotherapy with dopamine agonists and early combination LD/dopamine agonists). The role of peripheral pharmacokinetics factors is also critical and the use of controlled release LD formulations, of monoamine oxidase (MAO)-B and of catechol-O-methyltransferase (COMT) inhibitors may all, to a different degree, improve such phenomena. In the last decade, there has been a resurgence in surgical therapies in advanced PD, due to higher levels of accuracy and safety provided by the new surgical devices, and to a more precise localization of the target areas allowed by the neurophysiological mapping techniques. The surgical procedures currently used in advanced PD are stereotactic brain lesions (internal globus pallidus and subthalamic nucleus), chronic brain stimulation (of the same nuclei) and striatal grafting of dopamine-producing cells. All these procedures have already shown their efficacy in the management of severe fluctuations in PD, but their indications, and relative advantages and disadvantages, are still the subject of considerable debate and controversy.

Catechol O-Methyltransferase Inhibitors↗

PubMed2000

Constriction band of the arm following insertion of a pleuro-amniotic shunt.

In a 23-week fetus with a large left-sided pleural effusion a double pigtail pleuro-amniotic shunt was inserted uneventfully. A healthy infant was delivered at 38 weeks' gestation. One end of the shunt was in the thoracic cavity but the other end was found wrapped around the upper arm resulting in a constriction band. There was no impairment of the vascular supply to the limb or in its motor or sensory function and by 6 months of age there was only a faint ring still apparent around the upper arm.

Amniotic Band Syndrome↗

PubMed2000

Acute effects of substance P and calcitonin gene-related peptide in human skin--a microdialysis study.

Upon activation nociceptors release neuropeptides in the skin provoking vasodilation and plasma protein extravasation in rodents, but only vasodilation in humans. Pivotal peptides in the induction of neurogenic inflammation comprise calcitonin gene-related peptide and substance P, the latter being suggested to act partly via degranulation of mast cells. In this study substance P and calcitonin gene-related peptide-induced vasodilation, protein extravasation, histamine release, and sensory effects were investigated simultaneously in human skin by dermal microdialysis. The vasodilatory prostaglandin E(2) and the mast cell activator codeine served as positive controls. Substance P and calcitonin gene-related peptide applied intradermally via large cut-off plasmapheresis capillaries induced dose-dependent local vasodilation, but only SP provoked protein extravasation in concentrations greater than 10(-9) M. Substance P-induced (10(-8)-10(-6) M) protein extravasation was not accompanied by histamine release and was unaffected by cetirizine (histamine H1 blocker, 200 microg per ml). Only the highest concentration of substance P (10(-5) M) induced significant histamine release. Neither neuropeptide caused any axon reflex erythema or any itch or pain sensation, whereas mast cell degranulation by codeine dose dependently provoked itch, flare, protein extravasation, and histamine release. In human skin calcitonin gene-related peptide and substance P induce vasodilation by a mechanism not involving histamine. No evidence for neuropeptide-induced activation of nociceptors was obtained. Our results suggest that endogenous calcitonin gene-related peptide and substance P have no acute sensory function in human skin. The lack of neurogenic protein extravasation in humans can most probably be attributed to low local concentrations of this neuropeptide still sufficient to exert trophic and immunomodulatory effects (10(-11) M), but too low to induce protein extravasation (10(-8) M) or even mast cell degranulation (10(-5) M). J Invest Dermatol 115:1015-1020 2000

Adult↗

PubMed1996

Idiopathic intracranial hypertension in a young child without visual symptoms or signs.

A 7-year-old boy presented with a 4-week history of daily headache. His parents reported that he was unable to attend school the week prior to presentation. Intermittent nausea without vomiting was reported, but no blurred vision, photophobia, or diplopia were described. There was no history of trauma or recent systemic illness. The physical examination showed mild neck discomfort, no papilledema, and normal cranial nerve, motor and sensory functioning. Both a CT scan of the sinuses and an MRI of the brain were normal. Although the opening pressure was elevated, the cerebrospinal fluid was also normal. In previous accounts of idiopathic intracranial hypertension in children, concomitant papilledema, visual symptoms and/or palsy of the sixth cranial nerve are described. This case demonstrates that idiopathic intracranial hypertension in a young child can present as a daily headache without any visual symptoms or signs.

Acetazolamide↗

PubMed2000

Pain tolerance threshold: a pilot study of an objective measurement of spinal cord stimulator trial results.

OBJECTIVE: There is a lack of objective measurements of the spinal cord stimulator (SCS) trial results, which leads to increased number of failed permanent placements. Certain modes of sensory functions were tested as possible correlates with trial success. DESIGN: A convenience sample of 44 patients undergoing SCS trial underwent current perception threshold (CPT), pain perception threshold (PPT) and pain tolerance threshold (PTT) testing before and after the procedure. PPT and PTT were also recorded twice at the same period of time in 9 volunteers. RESULTS: PPT, but not PTT, showed an unacceptably high level of intra-individual variability in volunteers. CPT measurements did not produce significant changes after SCS use. PTT not only showed significant changes after SCS trial, but also correlated with the results of the trial and success of the permanent implantation. CONCLUSION: PTT may possibly serve as an objective measurement of the SCS trial outcome.

Journal Article↗

PubMed2006

Brownian dynamic model of the glycine receptor chloride channel: effect of the position of charged amino acids on ion membrane currents.

Glycine is the major inhibitory neurotransmitter in the brainstem and spinal cord, where it participates in a variety of motor and sensory functions. It activates a special type of ligand-gated membrane receptor, which provides for Cl- ion conductance of the neuronal membrane. Computer simulations of a single-channel current through this receptor have been carried out on the basis of Brownian (Langevin) dynamics. The dependence of the currents on pore diameter and the location of the charged amino acid residues have been obtained. It has been shown that the presence and the symmetry of the filter-forming residues determined not only the ion-selectivity of the channel but also increased transmembrane anion current.

Amino Acids↗

PubMed1999

Scanning electron microscopy of Oestrus ovis larvae (Diptera: Oestridae): skin armour and posterior spiracles.

The skin armour and posterior spiracles of L1, L2 and L3 of Oestrus ovis (Diptera: Oestridae) are described and documented photographically by a scanning electron microscope. The complex and variable morphology of the attack organs of larvae of different stages makes it easier to understand better their exceeding adaptability to the host. The SEM survey has also allowed an apparently unreported anatomic particular with a probable sensory function to be detected in L1.

Animal Structures↗

PubMed2000

The gastric emptying scan as a tool for surgical management of severe bowel dysfunction in spinal cord injury: 2 case reports.

We describe 2 patients with spinal cord injury (SCI) for whom the gastric emptying scan (GES) was crucial for determining the correct surgical approach in the therapeutic management of gastrointestinal complaints. Two men, ages 45 and 51 years, were admitted to a university hospital for delayed gastric complications from SCI. Both SCIs were traumatic, and the interval since injury was 18 months for the younger man and 6 months for the older man. Both men lacked voluntary motor and sensory function below the cord level of the lesion and had quadriplegia. Using GES, we measured motility (the cutoff for normal in this laboratory is 37%) and the time at which half the gastric contents were emptied (normal values are 45 +/- 8 min). Both patients had abnormal motility: residuals at 1 hour were above 50%. Half the gastric contents were emptied at 75 and 90 minutes, respectively. The therapeutic value of the GES was demonstrated for both patients, in combination with the history, physical examination, and abdominal radiographic studies. The first patient underwent ileostomy, and the second required a gastrostomy tube and a jejunostomy tube in addition to metoclopramide. The GES is a valuable diagnostic tool with an important role in the surgical management of patients with SCI.

Antiemetics↗

PubMed2001

Management of the irritable bowel syndrome.

Irritable bowel syndrome (IBS) is the most common disorder diagnosed by gastroenterologists and one of the more common ones encountered in general practice. The overall prevalence rate is similar (approximately 10%) in most industrialized countries; the illness has a large economic impact on health care use and indirect costs, chiefly through absenteeism. IBS is a biopsychosocial disorder in which 3 major mechanisms interact: psychosocial factors, altered motility, and/or heightened sensory function of the intestine. Subtle inflammatory changes suggest a role for inflammation, especially after infectious enteritis, but this has not yet resulted in changes in the approach to patient treatment. Treatment of patients is based on positive diagnosis of the symptom complex, limited exclusion of underlying organic disease, and institution of a therapeutic trial. If patient symptoms are intractable, further investigations are needed to exclude specific motility or other disorders. Symptoms fluctuate over time; treatment is often restricted to times when patients experience symptoms. Symptomatic treatment includes supplementing fiber to achieve a total intake of up to 30 g in those with constipation, those taking loperamide or other opioids for diarrhea, and those taking low-dose antidepressants or infrequently using antispasmodics for pain. Older conventional therapies do not address pain in IBS. Behavioral psychotherapy and hypnotherapy are also being evaluated. Novel approaches include alosetron; a 5-HT(3) antagonist, tegaserod, a partial 5-HT(4) agonist, kappa-opioid agonists, and neurokinin antagonists to address the remaining challenging symptoms of pain, constipation, and bloating. Understanding the brain-gut axis is key to the eventual development of effective therapies for IBS.

Antidiarrheals↗

PubMedDate not supplied

The effects of normal human variability and hand activity on sensory testing with the full Semmes-Weinstein monofilaments kit.

The first part of this study aimed to determine the effect of human variability on assessment using Semmes-Weinstein monofilaments. Fifteen healthy subjects were tested using a full monofilament kit of known calibration. When the subjects were retested, they responded to a different filament 48% of the time. The second part of the study aimed to determine the effects of vigorous hand activity on sensation, as measured with Semmes-Weinstein monofilaments. Forty randomly selected healthy subjects were assessed before and after they performed a brief, standardized gripping activity. After hand activity, the subjects responded to a different filament 53% of the time. In both parts of this study, the changes in monofilament results were random in direction and magnitude. The number of changes did vary between test sites, the radial nerve sites being most variable and the ulnar nerve sites least variable. It is concluded that the results of testing with the five smallest monofilaments in the full Semmes-Weinstein kit were not reliable in normal subjects and that they did not detect change in sensory function in normal subjects.

Adult↗

PubMed2003

A blueprint-based case study analysis of nutrition services provided in a midterm care facility for the elderly.

Ensuring nutritionally adequate food intake in institutions is a complex and important challenge for dietitians. To tackle this problem, we argue that dietitians need to adopt a systematic, integrative, and patient-centered approach to identify and manage more effectively organizational determinants of the quality of food intake under their control. In this study, we introduce such an approach, the blueprint-based case study, that we applied in the context of a midterm care facility for elderly patients. Data gathered through interviews and field observations were used to develop, from the perspective of key patient encounters, detailed representations of the food, nutrition, and nursing activities necessary to ensure adequate food intake. These service "blueprints" were developed to illustrate all activities that might potentially impact on the nutritional, sensory, functional, and social quality of patients' meals. They were also used as roadmaps to develop a case study analysis in which critical areas were identified and opportunities for improvement put forth, while considering services' resources and priorities. By providing a precise, objective, yet comprehensive mapping of the service operations and management, the blueprint-based case study approach represents a valuable tool to determine the optimal allocation of resources to insure nutritionally adequate food intake to patients.

Aged↗

PubMed2000

Factors affecting neurosensory disturbance after mandibular bilateral sagittal split osteotomy.

PURPOSE: The current study evaluated the incidence of subjective neurosensory disturbances after bilateral sagittal split osteotomy (BSSO) in relation to gender, age, indication for osteotomy, magnitude of mandibular movement, degree of manipulation of the inferior alveolar nerve at operation, side of the mandible operated, and complications during and after surgery. PATIENTS AND METHODS: Thirty patients (60 sides) who had undergone a BSSO were followed up for 1 year after operation. The patients were classified into different groups according to gender, age, indication for osteotomy, magnitude of mandibular movement, degree of manipulation of the nerve, and complications during or after surgery. A self-administered questionnaire was used at every follow-up to evaluate the sensations in the mental region. RESULTS: A statistically significant positive correlation was found between subjective neurosensory loss and the patient's age (P = .039), magnitude of mandibular movement (P = .044), and degree of manipulation of the nerve (P = .0007). However, no significant correlation was found between disturbances of sensation and gender, indication for osteotomy, side of the operated mandible, or intraoperative and postoperative complications. Even if all patients evaluated their sensation as "normal" 1 year postoperatively, 31% of them reported slightly altered sensation in the mental region. CONCLUSIONS: After BSSO, a prolonged neurosensory deficit is strongly related to age, the intraoperative magnitude of mandibular movement, and the degree of manipulation of the inferior alveolar nerve. However, a long-term sensory loss is very rare, and patients seem to adapt to a mild neurosensory deficit and report sensory function as "normal" despite slightly altered sensation.

Adolescent↗

PubMed2001

Hirschsprung's disease: a more generalised neuropathy?

BACKGROUND/PURPOSE: Aberrant neural crest migration is implicated in the pathogenesis of hindgut aganglionosis in Hirschsprung's disease (HSCR). Neural crest progenitors also give rise to a variety of cell types outside the gut, including nerves of the inner ear and peripheral nervous system. This study aims to determine whether such nerves are also affected in HSCR. METHODS: Pure tone audiometry and oto-acoustic emission tests were performed on 53 patients with Hirschsprung's disease and 28 age-matched controls. Forty-two children with Hirschsprung's disease and 30 age-matched controls also underwent neurologic evaluation, including quantitative peripheral tests of sensory function. RESULTS: Moderate to severe sensorineural hearing loss (1 profound [Waardenburg syndrome] and 3 high frequency) was detected in 4 children (8%) from the Hirschsprung's group. Abnormal (absent or reduced) oto-acoustic emission was detected in 77 of 102 ears (41 of 51 patients) in the HSCR group and 8 out of 48 ears (6 of 24 children) in the control group (75% v 17%; P<.0001). Two HSCR children had marked abnormalities on tests of peripheral nerve function. Significantly higher thresholds for vibration sensation were detected in HSCR versus controls (P<.05). CONCLUSION: Hirschsprung's disease may have a more generalised neuropathy than just that involving the affected bowel.

Adolescent↗

PubMedDate not supplied

Postoperative epidural analgesia and possible transient anterior spinal artery syndrome.

BACKGROUND AND OBJECTIVE: We present an unusual complication of epidural analgesia used to facilitate postoperative pain relief while allowing mobilization of the patient. CASE REPORT: A 65-year-old woman with a history of chronic obstructive pulmonary disease, atherosclerotic cardiovascular disease, chronic renal failure, and degenerative vertebral anatomy underwent resection of the left ureter due to obstructing tumor. The day following surgery, mobilization to an armchair was started, followed by a decrease in blood pressure. Soon after, flaccid paralysis with sparing of sensory functions, consistent with anterior spinal artery syndrome (ASAS), was diagnosed. CONCLUSIONS: This complication should be taken into account, especially in patients at risk, when considering epidural analgesia techniques in the postoperative period. Reg Anesth Pain Med 2001;26:274-277.

Aged↗