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Biomedical subjects

D Burke

Publications and source records attributed to D Burke.

At least 181 records · Page 10Linked to original sources

Reproducibility of a heteronymous monosynaptic reflex in biceps brachii.

The present study provides normal data for a new technique to assess conduction across the C5/C6 segments by recording a heteronymous monosynaptic reflex response from the contracting biceps brachii in response to stimulation of the median nerve in the cubital fossa. The reflex responses were reproducible and symmetrical, with a mean latency of 14.8 msec (S.D. 1.4 msec) and an absolute side-to-side differences of 0.5 msec (S.D. 0.29 msec). Latency was significantly correlated with both age and height, and multiple regression analysis provided the following equation: latency (msec) = 0.091 x height (in cm) + 0.036 x age (years) - 1.988. Amplitudes had wide scatter (22-365 microV on the right side) and positive skew. An amplitude less than 40% of that for the other side would be outside the 90th percentile. Five cases are described to illustrate the potential clinical utility of this test. However, whether this reflex is of diagnostic value can be answered only by a prospective study comparing it with other routine investigations.

Adult↗

Measurement of response to treatment in colorectal liver metastases.

Assessment of tumour response to chemotherapy is important when assessing efficacy of treatment and comparing differing therapeutic regimens. Percentage hepatic replacement (PHR) is commonly used to assess response to treatment of colorectal hepatic metastases. PHR is dependent not only on tumour volume, but also on hepatic parenchymal volume. The effect of tumour growth on hepatic parenchymal volume is unclear but is of importance owing to its effect on PHR. We assessed tumour and hepatic parenchymal weights in an animal tumour model using dissection, and tumour and hepatic parenchymal volumes in patients with colorectal hepatic metastases using CT scanning, in order to establish how hepatic parenchyma varied with change in metastasis size. There was no significant correlation between tumour and liver parenchyma in either the animal model (r = -0.03, P > 0.05) or the patient study (r = 0.3, P < 0.05). This suggests that hepatic parenchymal volume was preserved in the presence of increasing tumour volume. In a further study of computerised tomographic (CT) scans before and after treatment in patients whose tumours either responded to chemotherapy or continued to grow, change in PHR (median proportion of PHR change = 0.40) significantly (P = 0.04) underestimated the change in tumour volume (median proportion of tumour volume change = 0.56), particularly at higher (> 400 ml) volumes. There was good correlation between change in tumour volume and WHO criteria in assigning patients to tumour growth, stable disease or tumour response categories. This study suggests that, in clinical trials comparing colorectal liver metastasis treatments, metastasis volume and not PHR should be used to assess extent of disease and the effect of treatment.

Animals↗

Treatment interruptions and complications with two continuous hepatic artery floxuridine infusion systems in colorectal liver metastases.

Continuous hepatic artery floxuridine infusion benefits patients with colorectal liver metastases. Implanted infusion pumps are more expensive but may result in fewer treatment interruptions than when using an external pump connected to a port. We have assessed device-related complications, treatment interruptions and added nurse interventions in 95 patients undergoing a total of 959 treatment cycles via either implanted pump (64 patients) or port (31 patients). Compared with the implanted pump, the port was associated with a significant increase (P < 0.003) in catheter blockage (24/31 vs 2/64 patients), treatment interruption (15/265 vs 12/694 treatments) and added nurse intervention (80/265 vs 20/694 treatments). Survival in patients with colorectal liver metastases is limited and the complications of treatment should be kept to a minimum. An implanted subcutaneous infusion pump offers the benefit of a 3-fold lower incidence of treatment interruption and a 30-fold lower incidence of catheter blockage than when continuous infusion chemotherapy is given via an external infusion device.

Antimetabolites, Antineoplastic↗

Activity-dependent changes in impulse conduction in normal human cutaneous axons.

The present study was undertaken to determine if the axonal hyperpolarization produced by a brief train of impulses would impair neural transmission in cutaneous afferents of normal human subjects (n = 25). To assess changes in axonal excitability, a submaximal test stimulus was conditioned by a train of 10 supramaximal stimuli at 200 Hz. This produced a depression in excitability lasting up to 100 ms, demonstrable at nodes of Ranvier remote from the site of stimulus application, and probably due to activation of a slow K+ conductance. The effects of this change in excitability on neural transmission were assessed using a supramaximal test pulse. This revealed small but significant activity-dependent decreases in amplitude at conditioning-test intervals up to 20 ms and increases in latency at intervals up to 70 ms. Both the amplitude decrease and the latency increase were greater the longer the conduction distance. The reduction in amplitude of the compound sensory potential could be explained by temporal dispersion due to the increase in latency. It is concluded that, at the nodes of normal cutaneous afferents, the safety margin for impulse generation is sufficiently high that the activity-dependent hyperpolarization does not produce conduction block. It is likely that the previously described reductions in the amplitude of the compound sensory action potential in response to brief trains of stimuli were due to dispersion of the volley, not conduction failure, and that conduction failure does not occur in normal cutaneous axons solely by activation of slow K+ conductances.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The effects of propofol on rat transcranial magnetic motor evoked potentials.

INTRAOPERATIVE MONITORING OF motor evoked potentials (MEPs) may become a valuable test of spinal cord function during surgery. Unfortunately, MEP responses are affected by most common anesthetics. We studied the effect of intravenous propofol on transcranial magnetic MEPs (tcMMEPs) in the rat. Baseline tcMMEPs were recorded before administration of the drug. Each rat then received three induction doses of propofol, 10, 5, and 5 mg/kg (totaling 10, 15, and 20 mg/kg) and three successive 20-minute infusion doses at rates of 10, 20, and 40 mg/kg/h, respectively. An MEP intensity series was performed after each induction dose, during each infusion, and during a 20-minute recovery period. tcMMEPs recorded during the induction period demonstrated a significant, dose-dependent increase in onset latency and a marked decrease in amplitude. Infusion tcMMEPs displayed increased onset latencies but demonstrated a significant change in amplitudes only after the largest infusion dose. The MEPs approached baseline levels after discontinuation of the propofol. This study demonstrates that tcMMEPs can be successfully recorded from the rat during propofol anesthesia.

Anesthetics, Intravenous↗

Two-layer repair of the transversalis fascia is sufficient for inguinal hernia repair.

The Shouldice four-layer repair is considered to be the gold standard procedure for repair of inguinal hernia with low recurrence rates around 1%. Tension-free two-layer repair of the transversalis fascia may be all that is required to avoid recurrence. We compared the early recurrence rate after two-layer repair of the transversalis fascia or the standard four-layer Shouldice technique in a randomised study of elective inguinal herniorrhaphy. In 48 patients (53 repairs) who had a two-layer transversalis fascia repair, there was one recurrence (2%) in the first 12 months after operation, though there was one more recurrence within 36 months (total 4%). In 39 patients who had a four-layer Shouldice repair (42 repairs), there was no recurrence at 12 months but at 36 months two recurrences (5%) were found. We conclude that a two-layer repair of the transversalis fascia is anatomically correct, physiologically sound and can provide equivalent results to the standard Shouldice repair for inguinal hernia.

Adult↗

Transcranial electrical stimulation of the motor cortex in man: further evidence for the site of activation.

1. The motor cortex was stimulated electrically (vertex anode; cathode 6 cm lateral) in neurologically normal subjects undergoing surgery for scoliosis, and the evoked corticospinal volleys were recorded from the spinal cord using epidural electrodes. 2. Stimuli > 330 V produced a complex D-wave volley containing three separate peaks, with high-threshold components, 0.8 ms (D2) and 1.6 ms (D3), in advance of the lowest-threshold component (D1). As stimuli increased up to 1500 V, D3 replaced the later components completely, but there was no further latency 'jump'. 3. Brainstem stimulation using electrodes over each mastoid process produced a descending volley that had the same latencies as D3. At threshold, stimulation of the brainstem or spinal cord attenuated the D wave evoked by simultaneous cortical stimulation. 4. It is concluded that transcranial electrical stimulation of the motor cortex at high intensities can access corticospinal neurones at the pyramidal decussation, and that stimulation of the brainstem (and the spinal cord) preferentially accesses corticospinal axons. At threshold, motor cortex stimulation probably activates corticospinal neurones at or near the cerebral cortex.

Adolescent↗

Non-monosynaptic transmission of the cortical command for voluntary movement in man.

1. The possibility was investigated that, in man, some of the descending command for tonic voluntary wrist extension is transmitted to extensor motoneurones over a non-monosynaptic pathway. 2. Stimulation of the cutaneous superficial radial nerve at 3 times perceptual threshold depressed the electromyogram (EMG) of extensor carpi radialis (ECR) and the discharge of single ECR motor units, both with a mean central delay of 4.2 ms. Such stimuli depressed the response to transcranial magnetic stimulation of the motor cortex, but had little effect on the H reflex. 3. The possibility that the relative sparing of the H reflex was due to an alteration in transmission of the afferent volley for the H reflex was excluded. 4. The central latency of the cutaneous-induced depression of the discharge of single motor units in biceps brachii (C5-C6) was shorter by about 1 ms than that of the more caudal wrist and finger extensor motor units. This suggests that the locus for the cutaneous-induced effects was spinal but above the cervical enlargement. 5. The pattern of EMG depression (evoked by superficial radial but not palmar stimuli, in wrist extensors but not wrist flexors) is that previously described for the presumed propriospinal system of human subjects. 6. It is concluded that a significant component of the voluntary command for tonic wrist extension reaches the relevant motoneurone pool via a non-monosynaptic pathway. It is suggested that the interposed neurones could be C3-C4 propriospinal neurones.

Action Potentials↗

Fusimotor reflexes in relaxed forearm muscles produced by cutaneous afferents from the human hand.

1. This study was designed to determine whether cutaneous receptors in the hand exert reflex effects on fusimotor neurones innervating relaxed muscles. Recordings were made from fifty-four muscle spindle afferents in the radial nerve while the arm was held relaxed in a supporting frame. Cutaneous afferents were activated by trains of stimuli at non-noxious levels to the superficial radial nerve or to the palmar surface of the fingers. 2. For the population of muscle spindle afferents, the mean discharge rate was 7.1 +/- 6.4 Hz (range 0-24 Hz). Thirty-three per cent had no background discharge, and this occurred significantly more often in finger extensors than wrist extensors. 3. Trains of cutaneous stimuli produced no change in the discharge rates of the majority of spindle endings irrespective of whether the spindle afferent had a background discharge or was given one by muscle stretch. However, with two of forty afferents, the stimuli produced an increase in discharge at latencies of 135 and 155 ms. 4. With a further fourteen muscle spindle endings, the dynamic responses to stretch were measured 100-400 ms after the trains of cutaneous stimuli. For four spindle afferents there was a statistically significant change in the dynamic response to stretch occurring at conditioned-stretch intervals of 100-200 ms. For two afferents the dynamic response decreased by 17 and 26% and for two others it increased by about 24 and 37%. 5. While these results support the view that the level of background fusimotor drive is low in the relaxed state, they suggest that there is some dynamic fusimotor drive to completely relaxed muscles operating on the human hand, and that this drive can be altered reflexly by cutaneous afferent inputs from the hand.

Adult↗

Task-dependent reflex responses and movement illusions evoked by galvanic vestibular stimulation in standing humans.

1. To identify the vestibular contribution to human standing, responses in leg muscles evoked by galvanic vestibular stimulation were studied. Step impulses of current were applied between the mastoid processes of normal subjects and the effects on the soleus and tibialis anterior electromyograms (EMGs), ankle torque, and body sway were identified by post-stimulus averaging. The responses were measured when subjects stood on a stable platform or on an unstable platform and the effects of eye closure were also assessed. Responses were also recorded during voluntary contraction of the leg muscles and when subjects balanced a load equivalent to their own body in a situation where vestibular postural reflexes would not be useful. 2. At a mean post-stimulus latency of 56 ms, there were reciprocal changes in soleus and tibialis anterior muscle activity followed, at 105 ms, by larger responses of opposite sign. These were termed the short- and middle-latency responses, respectively. Both responses increased with stimulus intensity, but the short-latency response had a higher threshold. The early response had a similar latency to EMG responses evoked by rapid postural perturbations. Both responses were larger when the eyes were closed, but eye closure was associated with increased sway and EMG activity, and the responses were of similar magnitude when scaled to background EMG level. 3. Both short- and middle-latency EMG responses in soleus and tibialis anterior muscles produced small transient postural sways. The transient changes in EMG activity were followed by a larger prolonged sway which was not attributable to the activity in these muscles but rather to reflex or volitional adjustments to movements at other body segments. When subjects were prevented from swaying, the galvanic stimulus produced illusory movements in the opposite direction to the sway evoked when standing, and it is possible that the prolonged sway is a reaction to the illusion of sway. 4. The short- and middle-latency responses were modified during different postural tasks according to the dependence on vestibular reflexes. When the support platform was unstable, the EMG responses to galvanic stimulation were larger. There were no vestibular-evoked responses when seated subjects made voluntary contractions of the leg muscles or when they stood upright with the trunk supported, using the ankles to balance a body-like load.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Coupling between variations in strength and baroreflex latency of sympathetic discharges in human muscle nerves.

1. Pulse-synchronous multiunit muscle nerve sympathetic activity was recorded simultaneously from two nerves together with ECG in eleven healthy subjects; seven recordings were made from the two peroneal nerves during prolonged expiratory apnoeas and four from a radial and a peroneal nerve during lower body negative pressure of 10-40 mmHg. The neural records were displayed in mean voltage neurograms (time constant 0.1 s) and for each mean voltage burst the following measures were taken and related to each other: amplitude, duration, rise time, decay time and baroreflex latency (from the appropriate R-wave of the ECG to the peak of the burst). 2. Average baroreflex latencies were 1.3 s in the peroneal nerves and 0.9 s in the radial nerve. There were significant positive correlations between both the amplitudes and the baroreflex latencies of corresponding bursts in peroneal-peroneal recordings and in radial-peroneal recordings. 3. In all nerves baroreflex latency shortened significantly when burst amplitude increased. The correlation between burst amplitude and baroreflex latency was weaker in the radial than in the peroneal nerve. The average variation of baroreflex latency in peroneal-peroneal recordings was 0.20 +/- 0.02 s in both legs, and in radial-peroneal recordings the variation was 0.09 +/- 0.01 s in the radial nerve and 0.12 +/- 0.02 s in the peroneal nerve. 4. When peroneal burst amplitudes increased, burst duration increased. This was due to increases of both the rise time and the decay time of the burst, the latter being the greater.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Deficits in the function of small and large afferent fibers in confirmed cases of carpal tunnel syndrome.

Nerve conduction studies and measurements of thermal thresholds (hot and cold) were performed in 25 healthy control subjects and 24 patients with carpal tunnel syndrome: first, to compare the extent of abnormality demonstrable in the function of large and small afferent axons; second, to correlate these abnormalities with clinical severity; and third, to validate a modified form of palmar stimulation as an additional neurophysiological test in suspected carpal tunnel syndrome. The routine nerve conduction studies compared the amplitudes and conduction velocities from digit II and digit V to wrist and for the digit-II potential between wrist and elbow. With palmar stimulation, the palm-to-wrist segment was compared to the simultaneously evoked antidromic digital potential (palm-to-index). Thermal threshold testing involved determination of hot and cold thresholds for digit II and digit V using an automated forced-choice procedure. In the patients there was selective slowing of conduction across the palm-to-wrist segment with normal velocities distally and proximally, and there was clear evidence of abnormal small-fiber function, with higher thresholds for both hot and cold sensation. However, the thermal abnormalities also involved the ulnar territory, equally so for cold threshold but significantly less so for hot threshold. Thermal threshold testing confirmed the clinical impression that small-fiber dysfunction is important in carpal tunnel syndrome, but the abnormal findings for the ulnar-innervated digit V suggest that this test will not be routinely useful for the early detection of compression or entrapment neuropathies.

Adult↗

A role for a low level mechanism in determining plaid coherence.

A number of recent studies have suggested that the "intersection of constraints" model of two dimensional motion perception, put forward by Adelson and Movshon [(1982) Nature, 300, 523-525], is incomplete. Evidence has been mounting that there is a second two-dimensional motion sensitive mechanism which is monocular and which appears to respond directly to the movement of the intersections (or "blobs") in a two-dimensional image. The current study extends these findings by demonstrating that the perceived coherence of a drifting plaid is largely under the control of a monocular mechanism. Prior exposure to a similarly drifting grating or plaid substantially raises the coherence threshold of a test plaid only if the same eye is adapted and tested. The threshold elevation is much more modest if the test plaid is presented to the unadapted eye, suggesting that coherence judgements are primarily based on the activity level of a monocular process--possibly the "blob tracking mechanism". The results of Expt 2 suggest the possibility that this monocular mechanism is inhibited by binocular exposure.

Adaptation, Ocular↗