Biomedical subjects

D Grob

Publications and source records attributed to D Grob.

At least 37 records · Page 2Linked to original sources

PubMed1997

Dantrolene sodium reduces the enhanced leakage of creatine kinase caused by ethanol, cocaine, and electrical stimulation in isolated fast and slow muscles of rat.

Binge drinking of alcohol, cocaine overdose, or overexertion can lead to rhabdomyolysis characterized by elevated creatine kinase (CK) and myoglobin in the serum, myoglobinuria, and muscle tenderness. Our previous studies showed that ethanol, cocaine, and electrical stimulation enhanced the leakage of CK from isolated soleus and extensor digitorum longus (EDL) muscles of rat. Dantrolene sodium was reported to reduce the muscle damage and elevated serum CK levels in exercised rats. The present study was aimed at testing whether dantrolene can reduce the enhanced leakage of CK from isolated rat soleus and EDL muscles caused by ethanol, cocaine, and electrical stimulation. After 4-hr incubation in oxygenated physiological solution at 37 degrees C, the mean leakage of CK was 1.56 units/mg of muscle in soleus and 0.89 units/mg in EDL. Ethanol at 0.2% increased the leakage of CK by 47% (p < 0.05) in soleus and by 26% in EDL. Cocaine at 1 mM increased the leakage of CK by 55% (p < 0.05) in soleus and by 27% in EDL. Electrical stimulation at 1 Hz for 4 hr increased the mean leakage of CK by 100% (p < 0.05) in soleus and 127% (p < 0.05) in EDL. Dantrolene sodium reduced the enhanced leakage of CK caused by ethanol, cocaine, and electrical stimulation significantly in soleus and slightly in EDL. Dantrolene may involve myoplasmic free Ca2+ in these beneficial effects as in malignant hyperthermia, and may be useful in the treatment of rhabdomyolysis associated with acute alcoholic myopathy, cocaine overdose, and overexertion.

Animals↗

PubMed1996

[Stenosis of the lumbar spine in elderly persons. Surgical decompression].

The degenerative changes in the lumbar vertebral spine frequently appear as encroachment of the lumbar spinal canal. Degenerative changes of the anatomical structures dictate the location of the stenosis, which are divided in central or lateral stenosis of the lumbar spinal canal. According to this localization, more radicular symptoms in a lateral stenosis might be prevalent in contrast to the mixed symptoms of a central stenosis. Operative decompression might be indicated in cases with correlation of clinical symptoms and radiological findings. The operative treatment aims at a satisfactory decompression without creating iatrogenic instability. An additional fusion might be avoided in cases without apparent instability. Adequate operative decompression is most efficient concerning reduction of pain and increasing of walking distance.

Aged↗

PubMed1996

The effectiveness of various cervical orthoses. An in vivo comparison of the mechanical stability provided by several widely used models.

STUDY DESIGN: The amount of motion allowed by various cervical orthoses was compared with the amount of unrestricted neck motion in vivo. OBJECTIVES: To determine how much mechanical stability commonly used cervical orthoses provide to the wearer. SUMMARY OF BACKGROUND DATA: Few studies have compared quantitatively the restriction of motion from cervical orthoses that are commonly prescribed for patients. No studies have used methods allowing measurement of all three rotations throughout the range of motion in passive and active tests. Previous studies may have overstated the amount of restriction provided resulting from the methods used. METHODS: Five subjects were tested for cervical range of motion in flexion-extension, axial, rotation, and lateral bending. Each was tested with no collar, with soft collar, with Philadelphia collar, with Philadelphia collar with thoracic extension, and with sterno-occipital mandibular immobilizer brace. Each test was conducted passively and actively. Measurements were taken with the CA-6000 Spine Motion Analyzer, a highly accurate and precise computerized linkage system that simultaneously records all three rotations in real time. RESULTS: All orthoses restricted motion to some extent. Generally, the collars ranked (from least restrictive to most restrictive): soft, Philadelphia, Philadelphia with extension, and sterno-occipital mandibular immobilizer brace. However, the differences were not usually large, and the collars did not restrict motion as much as previously reported. No collar restricted the motion of any of the subjects to less than 19 degrees of flexion-extension, 46 degrees of axial rotation, or 45 degrees of lateral bending, and most subjects demonstrated significantly more motion. CONCLUSIONS: Although cervical orthoses can be helpful for other reasons, they do not provide a high level of mechanical restriction of motion. Additionally, the restriction they do provide can vary widely between people. Prescribing physicians should consider the relative merits of the various orthoses before deciding whether they will meet a patient's needs. The differences between the collars tested may not be enough to justify one of the more expensive or less comfortable collars.

Adult↗

PubMed1996

Predictors of bad and good outcome of lumbar spine surgery. A prospective clinical study with 2 years' follow up.

STUDY DESIGN: Based on prospective assessment, patients with lumbar disc surgery were examined to determine reliable predictors for clinical outcome. OBJECTIVES: The prognostic value of a screening checklist developed in a previous study was evaluated in a 2-year follow-up. SUMMARY OF BACKGROUND DATA: Outcome studies of lumbar disc surgery document a success rate between 49-90%. It has been shown that a number of medical history data and sociodemographic and psychodiagnostic findings are of prognostic value for the outcome of lumbar spine surgery. METHODS: In addition to clinical and neuroradiologic examinations, 164 patients took part in a standardized interview. Eighty-two percent participated in a follow-up performed 2 years after the operation. Preoperative findings, outcome, and prediction of three diagnostic subgroups were compared. Eighty-three (51%) patients had disc herniation only, 29 (18%) had disc herniation and other relevant back diagnoses, and 51 (31%) had no disc herniation but had other relevant back diagnoses. RESULTS: In patients with disc herniation only, good results were observed in 53%, moderate in 19%, and bad in 28%. The accuracy of prediction of the postoperative result was 75% for the patients with good outcome and 86% for those with bad outcome. In the group of patients with diagnoses other than disc herniation, the success rate of the operation was 38% good, 28% moderate, and 41% bad, but the predictor score was not as useful as for the other groups. CONCLUSION: Patients with a high risk of a bad operation outcome after lumbar discectomy could be identified preoperatively. It is suggested that those patients take part in a pain management approach instead of or in addition to surgical intervention.

Adolescent↗

PubMed1996

Direct pediculo-body fixation in cases of spondylolisthesis with advanced intervertebral disc degeneration.

In inveterate cases of grade 2-3 spondylolisthesis (degenerative or spondylolytic), segmental mobility may be reduced by radiologically confirmed disc resorption. Fusion may be indicated in patients with persistent pain. A simple technique for fusion without reduction of the spondylolisthesis is presented. Fixation of the segment is achieved by two cancellous bone screws inserted bilaterally through the pedicles of the lower vertebra into the body of the upper slipped, vertebra. The cases of 16 patients with an average follow-up of 31 months (range 24-27 months) treated with this direct pediculo-body fixation are presented. Clinical evaluation showed significant decrease in pain and, in patients with concomitant spinal stenosis, walking distance without pain improved from between 500 and 1000 m to more than 3000 m. Radiologically, fusion was observed in all cases. The presented technique of internal fixation of a slipped segment in the degenerative lumbar spine represents a simple minimally traumatic procedure with successful clinical and radiological outcome. Additional procedures, such as decompression of the spinal canal, may be performed.

Bone Screws↗

PubMed1996

Foraminal changes with distraction and compression of the L4/5 and L5/S1 segments.

The width of the foramen in the lumbar spine is directly related to the position of the vertebrae. In an MRI study the measurements of the cross-sectional area of the neuroforamen of L4/5 and L5/S1 in neutral position, segmental distraction and compression were calculated. Nine cadaver specimens were investigated and the foraminal width of L4/5 and L5/S1 was measured. In both segments of all specimens the foraminal space significantly enlarged under distraction and decreased under compression. In the L4/5 segment the average relative difference between distraction and compression was 27%.

Adult↗

PubMed1996

[Post-traumatic atlanto-axial arthrosis].

Eight patients with post-traumatic chronic cervical syndrome and degenerative changes of the upper cervical spine, were treated with suboccipital fusion. After a mean follow up of 60 months (58-64), the patients were examined. Three patients had died during the follow-up period. A solid fusion was achieved in all cases. Significant reduction of pain and increased quality of life were established.

Adult↗

PubMed1996

Production and role of cytokines in the CNS of mice with acute viral encephalomyelitis.

Semliki Forest Virus (SFV) causes a more severe acute encephalomyelitis in B6 than in SJL mice despite similar T cell proliferation and antibody responses in these two strains. To determine the immunological mechanisms that may contribute to this difference, CNS tissues from SFV-infected B6 and SJL mice were analyzed for viral replication, inflammatory responses and cytokine production, by semiquantitative reverse transcriptase-PCR and immunohistochemistry. Although initially similar on day 2 p.i., SFV replicated to higher viral titers in B6 than SJL mice on days 4 and 7 p.i. Infectious virus was cleared from both strains by day 10 p.i. There were no differences in numbers of CD4+, CD8+ or MHC class I and II+ inflammatory cells at any time point. Higher levels of IL-4 mRNA, lower levels of TNF-alpha, IL-6, IL-1 beta and IL-2 mRNAs and lower IL-2+ and IFN-gamma+ cells were found in B6. These findings suggest that despite comparable immune responses, different patterns of cytokine production correlated with higher levels of virus in the brains and more severe clinical disease in B6, and more efficient clearance of virus and less severe disease in SJL mice.

Acute Disease↗

PubMed1996

Case report: diclofenac-induced rhabdomyolysis.

A case is described in which, after administration of diclofenac for 13 days for arthritis attributed to gout, the patient experienced erythema multiforme followed by muscle weakness, elevation of serum creatine phosphokinase (CPK) level from 101 to 83,770 U/L, 100% muscle isoenzyme, blood urea nitrogen (BUN) level from 15 to 87 mg/dL, creatinine level from 1.0 to 2.1 mg/dL and urine myoglobin level to 1,190 micrograms/dL (N < 1.2). The diagnosis was rhabdomyolysis due to diclofenac, with myoglobinuria resulting in mild renal failure. Treatment consisted of discontinuing diclofenac and administering sufficient fluids to prevent progression of myoglobinuric renal failure. Serum CPK level gradually returned to normal by day 50, BUN and creatinine levels by day 28, and muscle strength between day 90 and 180. Rhabdomyolysis due to diclofenac or to other nonsteroidal antiinflammatory drugs has not been reported.

Adult↗

PubMed1996

Enzyme therapy of xeroderma pigmentosum: safety and efficacy testing of T4N5 liposome lotion containing a prokaryotic DNA repair enzyme.

Xeroderma pigmentosum (XP) is a rare genetic disease in which patients are defective in DNA repair and are extremely sensitive to solar UV radiation exposure. A new treatment approach was tested in these patients, in which a prokaryotic DNA repair enzyme specific for UV-induced DNA damage was delivered into the skin by means of topically applied liposomes to supplement the deficient activity. Acute and chronic safety testing in both mice and humans showed neither adverse reactions nor significant changes in serum chemistry or in skin histology. The skin of XP patients treated with the DNA repair liposomes had fewer cyclobutylpyrimidine dimers in DNA and showed less erythema than did control sites. The results encourage further clinical testing of this new enzyme therapy approach.

Adolescent↗

PubMed1996

[Surgical therapy in radicular symptoms of the degenerative cervical spine].

Radicular pain is a common feature in day-to-day clinical practice. Only a small percentage of patients with persistent pain and/ or neurological deficit need surgical decompression. Exact anatomical localization of the decompressive agent and the correlation of clinical symptoms and radiological findings are mandatory. In most cases, surgery is performed by an anterior approach; by which the causative agent is removed. In cases with narrowing of the neural foramen total resection of the uncus is indicated. Additional fusion supports the physiological cervical lordosis.

Adult↗

PubMed1995

The role of motor evoked potentials in psychogenic paralysis.

STUDY DESIGN: This prospective clinical study identified patients in whom paralysis developed after lumbar surgery. OBJECTIVE: To determine whether patients with psychogenic paralysis could be identified using noninvasive techniques. SUMMARY OF BACKGROUND DATA: Before the advent of transcranial magnetic stimulation, no clinically applicable, noninvasive technique was available to confirm the integrity of the corticospinal tract. METHODS: Patients with suspected postoperative psychogenic paralysis were evaluated by clinical examination and neurophysiologic work-up, including transcranial magnetic stimulation. RESULTS: Six patients with psychogenic paralysis were identified in a 15-month period. In each case, motor evoked potentials could be demonstrated from the affected muscle(s), thus obviating the need for further invasive imaging or surgical exploration. CONCLUSIONS: Transcranial magnetic stimulation is a reliable, painless, and noninvasive technique for demonstrating structural integrity of the corticospinal tracts.

Adult↗

PubMed1995

Fiber composition and fiber transformations in neck muscles of patients with dysfunction of the cervical spine.

Biopsies of ventral neck muscles (sternocleidomastoid, omohyoid, and longus colli) and dorsal neck muscles (rectus capitis posterior major, obliquus capitis inferior, splenius capitis, and trapezius) were taken from 64 patients who underwent spondylodesis for cervical dysfunction of different etiologies. The muscle fibers were classified histochemically as type I, IIA, IIB, or IIC (transitional or intermediate fibers) according to the pH lability of their myofibrillar ATPase. Signs of muscle fiber transformations were observed in all muscles investigated, as evidenced by an increased relative amount of type-IIC fibers. The transformations occurred independently of (a) the type of muscle (i.e., more "postural" or more "phasic"), (b) the sex and age of the patient, (c) the type of condition, and (d) the presence of additional neurological deficits. Thus, the same pattern of muscular reaction was found in patients with rheumatoid arthritis as in patients with soft-tissue injuries of the neck (e.g., "whiplash injury"). In the ventral muscles and the obliquus capitis inferior, the occurrence of transformations correlated strongly with the duration of symptoms; in the ventral muscles the vast majority of transformations were encountered in patients with a shorter history of symptoms, whereas in the obliquus capitis inferior the reverse occurred. In the other dorsal muscles, no correlation with the duration of symptoms was found. Muscles in which transformations had ceased displayed, on average, a significantly higher percentage of fast type-IIB fibers than were found in muscles with ongoing transformations. This strongly indicates that the transformations proceeded in the direction from "slow oxidative" to "fast glycolytic."

Adolescent↗

PubMed1995

Normal motion of the lumbar spine as related to age and gender.

The CA-6000 Spine Motion Analyzer was used to measure the lumbar spine's range of motion (ROM). One hundred and four asymptomatic volunteers were examined to obtain normal values for flexion/extension, lateral bending, and axial rotation. A detailed error analysis was conducted to investigate the inter- and intraobserver reliability of the measurement equipment, the differences between passive and active examination, the effects of stretching exercises before examination, and the diurnal changes related to lumbar spine ROM. Subjects were divided into groups by age and gender. Values for each group were compared with respect to age and gender. The measurements were found to be consistent and repeatable. Stretching exercises were observed to increase ROM. Passive examination was recommended to achieve maximum ROM. ROM was observed to increase during the course of the day. A normative database was established showing significantly decreased motion as age increased, but no gender differences were discovered. The validity of the axial rotation values due to fixation difficulties is questioned.

Adult↗

PubMed1995

Cotrel-Dubousset and Harrington Instrumentation in idiopathic scoliosis: a comparison of long-term results.

Between 1968 and 1977, 72 patients with idiopathic scoliosis underwent Harrington Instrumentation (HI). Between 1985 and 1988, 21 patients with idiopathic scoliosis had posterior spinal fusion with Cotrel-Dubousset instrumentation (CDI). All patients were operated by the same orthopedic surgeon. None of the CDI patients had postoperative brace or cast protection, the HI group had on average 6 months' postoperative brace treatment. The two groups of patients were comparable in age, sex, and type of curves. The HI group and CDI group were reexamined with clinical and radiological assessment after mean periods of 148 months and 60 months respectively. The average preoperative Cobb angle in the CDI group was 59.9 degrees (HI group 67.8 degrees), which improved to 20.8 degrees (HI group 33 degrees) postoperatively--a correction of 66.3% (HI group 51.3%). The loss of correction on reassessment amounted to 5% in the CDI group and 20.7% in the HI group. In both groups, the mean rib hump height was reduced to 2.2 cm. In 40% of the Harrington patients, a flat back was found, but this was not related to clinical back pain. The rate of complications and reintervention was 9.5% in the CDI group and 8.3% in the HI group. There were no neurological complications. Subjectively, 86% of the Harrington patients and 95.2% of the CDI patients rated the results of their operation as "good" or "very good." The CDI group showed better results in correction of the Cobb angle and loss of correction, while saving one mobile lumbar segment. The correction of the rib hump showed the same results for both techniques. Blood loss and operation time was much lower in the HI group. However, the rate of complications was similar in both groups.

Adolescent↗

PubMed1995

Rhabdomyolysis and myoglobinuric acute renal failure associated with classic heat stroke.

Classic heat stroke is a disorder of thermal regulation that predominantly affects elderly patients during heat waves. In contrast to exertional heat stroke, rhabdomyolysis and myoglobinuric acute renal failure are considered to be unusual manifestations of classic heat stroke. We retrospectively reviewed the charts of seven patients admitted to Maimonides Medical Center with classic heat stroke over a 3-day period during a heat wave in July 1993. Three of these patients with classic heat stroke had rhabdomyolysis, but no renal failure; two completely recovered; and one had an ataxic gait disturbance. Three additional patients had rhabdomyolysis and myoglobinuric acute renal failure; one of them completely recovered, one survived with quadriplegia, and one died. Our findings suggest that rhabdomyolysis and myoglobinuric acute renal failure are common manifestations of classic heat stroke. Recognition of this complication warrants rigorous hydration and alkalinization of the urine to prevent or attenuate myoglobinuric acute renal failure.

Acute Kidney Injury↗

PubMed1995

Effect of alcohol and electrical stimulation on leakage of creatine kinase from isolated fast and slow muscles of rat.

Binge drinking of alcohol may lead to acute alcoholic myopathy with rhabdomyolysis, which is characterized by skeletal muscle damage, elevated serum creatine kinase (CK), and myoglobinuria. This study was undertaken to test whether alcohol acts directly on the skeletal muscles to enhance the leakage of CK, and to assess the influence of fiber-type composition and repetitive contractions of the muscle on the effect of alcohol. After 4 hr of incubation in normal physiological solution at 37 degrees C, mean leakage of CK was 0.7 units/mg from isolated rat extensor digitorum longus (EDL), which has more fast-twitch glycolytic muscle fibers, and 1.2 units/mg from the soleus, which has more slow-twitch oxidative muscle fibers. Ethanol at 0.1, 0.2, and 0.5% concentrations caused significantly greater increase in leakage of CK from soleus than from EDL. In normal physiological solution, electrical stimulation at 1 Hz for 4 hr increased the leakage of CK by about the same degree in both EDL and soleus. In the presence of 0.1 and 0.2% ethanol, electrical stimulation markedly potentiated the alcohol-induced leakage of CK from both soleus and EDL. These results indicate that alcohol increases the leakage of CK by acting directly on skeletal muscle fibers, especially of the slow-twitch oxidative type, and that repeated muscle contractions potentiate the alcohol effect. These studies suggest that exercise may increase the chances of rhabdomyolysis in the alcoholics.

Animals↗

PubMed1995

Effect of ethanol on function of the rat heart and skeletal muscles.

The present study was undertaken to evaluate the acute effects of ethanol on responses of the rat heart and skeletal muscles both in vivo and in vitro. In the anesthetized rat, intravenous infusion of ethanol at 0.1-0.5 g/kg body weight (33-167 mM) decreased the breathing rate by 8-83%, heart rate by 4-52%, and QRS amplitude by 5-27%, and increased the P-R interval by 1-49%. In the anterior tibialis muscle subjected to repetitive nerve stimulation at 100 Hz for 0.5 sec, ethanol at 0.1 g/kg increased the amplitude of the muscle action potential (AP) by 7%, whereas at 0.5 g/kg it decreased the muscle AP by 32%. The nerve-evoked tetanic tension was reduced by 7-34% at 0.1-0.5 g/kg ethanol. In the isolated rat heart, perfusion of ethanol at 0.1-3.0% (22-651 mM) decreased the heart rate by 8-48% and QRS amplitude by 10-39%, and increased the P-R interval by 5-61%. Left ventricular pressure was increased by 10% at 0.1% ethanol, and decreased by 80% at 3.0% ethanol. In the isolated rat phrenic nerve-diaphragm muscle preparation subjected to repetitive nerve stimulation at 100 Hz for 0.5 sec, 0.1-3.0% ethanol decreased the amplitude of the nerve AP by 5-89%, nerve-evoked muscle AP by 2-96%, and peak tetanic tension by 1-87%. On repetitive direct muscle stimulation at 100 Hz for 0.5 sec, 0.1-3.0% ethanol decreased the amplitude of the muscle-evoked muscle AP by 8-65%, and muscle-evoked tetanic tension by 2-65%. These studies indicate that ethanol causes smaller reduction in responses of the heart and skeletal muscles at clinical concentrations, but marked reduction in these responses at higher concentrations due to direct action on excitability of these tissues. At higher concentrations, ethanol causes greater reduction in excitability of the skeletal muscle than of the heart.

Animals↗