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Biomedical subjects

G Racz

Publications and source records attributed to G Racz.

17 recordsLinked to original sources

Pro-apoptotic and anti-apoptotic molecules affecting pathways of signal transduction.

Selective inhibition of the "false" proliferative signals via targeting tyrosine kinases resulting in the induction of apoptosis by depletion of the "survival factors" is one of the most studied and widely accepted concepts of modern chemotherapy. We have synthesized a series of potent tyrosine kinase inhibitors and tested these compounds for apoptosis induction. Some of the tyrosine kinase inhibitors caused either apoptotic or cytoplasmic vacuolar cell death in various tumor cell cultures. The somatostatin analogue oligopeptide TT-232, which indirectly inhibits tyrosine kinases, exerted a dose-dependent apoptosis-inducing effect. The tumor growth-inhibitory effect of TT-232 and some tyrosine kinase inhibitors has also been proven by in vivo experiments, using human tumor xenografts. On the other hand, a dose-dependent pro- or anti-apoptotic activity of (-)-deprenyl has been shown in melanoma cell cultures, the lower doses inhibiting and the higher doses inducing apoptosis. Various metabolites of (-)-deprenyl are responsible for these actions. The effect of (-)-deprenyl is connected with depolarization of mitochondrial membranes. The kinase inhibitors act on the growth factor receptor signaling pathways (survival factor pathways) and initiate the caspase cascade. The key enzyme for the action of both pro-apoptotic and anti-apoptotic compounds is caspase 3.

Animals↗

Technical aspects of radiofrequency.

Radiofrequency (RF) is an alternating electric field with an oscillating frequency of 500,000 Hz. If the resulting current flows through a percutaneously introduced electrode, heat will be produced around the electrode because the body tissue acts as a resistor. RF can, therefore, be used to ablate nervous tissue in the treatment of chronic pain. This method has gained acceptance for percutaneous cordotomy and for the treatment of trigeminal neuralgia. For spinal pain, the method had little success initially, but since the introduction of small diameter instrumentation, the results have markedly improved. he mechanism of action of RF has not been challenged until recently even though there was awareness that some observations were not consistent with the heat concept. The formation of heat is not the only occurrence during RF treatment, however. The tissue surrounding the electrode is also exposed to the RF electric field. This exposure has a biological effect as has been demonstrated both in cells in a cell culture and in the exposure to RF of dorsal root ganglia, resulting in transsynaptal induction of early gene expression in the dorsal horn. The mode of action of RF is, therefore, uncertain at the moment. The method of pulsed RF is based on the concept that the production of heat has been a by-product of RF treatment and that the clinical effect is due to exposure to the electric field. In pulsed RF, the generator output is interrupted to allow for the elimination of heat in the silent period. The early results have been encouraging, but the results of controlled, prospective studies are not yet available. Since there are now 2 almost diametrically opposed views on the mode of action of RF, it is difficult to give recommendations for treatment. The decision is easy for indications for which heat RF has traditionally been contraindicated such as the treatment of peripheral nerves and trigger points. When the application of heat carries a potential risk, for instance if the dorsal root ganglion is the target structure, the use of pulsed RF is also recommended. As for the medial branch the situation is controversial. Since there are controlled studies available showing the effect of heat lesions, it is recommended that the technique should not be changed until further studies have been completed. Finally, the equipment for RF treatment is described and safety issues are discussed.

Journal Article↗

Chronic pain and self-efficacy: the effects of age, sex, and chronicity.

Higher self-efficacy (SE) is associated with lower pain ratings in chronic pain patients, although longer experience with chronic pain leads to lower SE scores. Self-efficacy in pain patients does not appear to be clearly related to sex or age, however. This study investigated the effects of gender, age, length of pain experience (chronicity) on SE and pain ratings. Archival data from the records of 187 patient's charts were evaluated for demographic information, chronicity, pain ratings and SE. Analyses found a significant inverse relationship between SE and pain ratings (r = -.22) and lower SE for young adult patients. Results support the conclusion that enhanced SE is an important psychosocial intervention in the treatment of chronic pain patients.

Journal Article↗

Subdural blood patch for the treatment of persistent CSF leak after permanent intrathecal catheter implantation: a report of two cases.

A CSF leak that persists despite conservative therapy may significantly increase the morbidity associated with implantable intrathecal drug delivery systems. This report presents 2 cases where the application of a subdural blood patch led to the satisfactory resolution of a persistent CSF leak after previous epidural blood patches had failed.

Journal Article↗

Myelinated fibers of spinal cord blood vessels--sensory innervation?

Innervation of the ventral spinal artery from the lumbosacral region of dogs was studied using light, scanning, and transmission microscopy. Microscopy revealed myelinated fibers, a new observation, in addition to unmyelinated fibers expected on the basis of previous studies of autonomic innervation of this blood vessel. The myelinated axons may be sensory fibers.

Animals↗

The Development of a Technique for Radiofrequency Lesioning of Splanchnic Nerves.

This article describes the development of a technique for radiofrequency lesioning of the splanchnic nerves. It features point neurolysis and improvement in safety from previously described techniques with the use of a curved, blunt needle. After extensive anatomic studies, the site of entry has been identified 4 cm lateral to the spinous process at the costovertebral angle of either the T11 or T12 vertebral body, and the placement of the needle tip at the junction of posterior two thirds to the anterior one third of the vertebral body. The use of a sharp, straight needle has been discouraged to prevent pneumothorax, and bowel, kidney, or nerve root injury. The radiofrequency lesion permits a point neurolysis, thus decreasing the rate of complications. Our experience of 22 patients treated with this technique has been complication-free, and the outcome was effective for all 10 patients with cancer. In the nonmalignancy group, some patients needed a second neurolysis (radiofrequency) procedure 4 months apart. There were also no secondary complications in these patients. We expect multicenter data accumulation in the coming years, which will determine the true efficacy of the radiofrequency of splanchnic nerves.

Journal Article↗

Indications and Technique of Thoracic(2) and Thoracic(3 )Neurolysis.

This article reviews the technique of thoracic (T)(2) and T(3) sympathetic ganglion block and neurolysis. Historic aspects of this technique are described. The concept of radiofrequency thermocoagulation (RFTC) of T(2) and T(3) is discussed and the technique is detailed. This procedure is useful for complex regional pain syndrome (CRPS), vascular compromise, and neuropathic pain syndromes of upper extremities. It is an alternative to stellate ganglion ablation and may be useful for patients with sympathetically maintained pain who have persistent pain after stellate ganglion procedures.

Journal Article↗

Neuroaugmentation in the treatment of complex regional pain syndrome of the upper extremity.

The authors report their results on 36 patients with advanced stages of complex regional pain syndrome. They were treated with either spinal cord stimulation, or peripheral nerve stimulation, and in some cases with both modalities. Thirty six months after implantation the reported pain measured on visual analogue scales was an average of 53% better, this change was statistically significant. Analgesic consumption decreased by about 50% or was reportedly more effective. The authors conclude that in late stages of complex regional pain syndrome, neuroaugmentation is a reasonable option when alternative therapies have failed.

Adult↗

Dose effectiveness and safety of butorphanol in acute migraine headache.

This study was undertaken to compare the effectiveness and safety of three dosage levels of butorphanol in 52 patients with acute, severe migraine headache. After baseline evaluation, patients were given a dose of butorphanol 1.0, 2.0, or 3.0 mg intramuscularly on a double-blind basis. Assessments of pain intensity and pain relief using 100 mm linear analog scales (LAS), vital signs, and medication side effects were made at 15, 30, 45, and 60 minutes after the dose. All three treatment groups were similar in baseline characteristics. Each dose of butorphanol demonstrated a significant decrease in pain intensity LAS compared to baseline and increase in pain relief LAS over the observation period. The majority of analgesic response was observed at the first (i.e., 15-min) assessment. Doses of 2.0 and 3.0 mg produced significantly greater analgesia than did 1.0 mg at all posttreatment evaluations. No significant difference was apparent between the 2.0- and 3.0-mg doses. Adverse cardiovascular and respiratory depressant effects were not observed. An analgesic response to butorphanol 2.0 and 3.0 mg is clearly and rapidly evident and near maximum 30-45 minutes after administration. We conclude that in these doses butorphanol provides effective and safe analgesia for patients with acute migraine headache.

Acute Disease↗

Treatment of upper extremity reflex sympathetic dystrophy with joint stiffness using sympatholytic Bier blocks and manipulation.

Twenty patients with reflex sympathetic dystrophy involving the upper extremity with associated joint stiffness were treated by manipulation under Bier blocks composed of lidocaine, methylprednisolone, and reserpine or guanethidine. Depending on the patients' response, repeat blocks were performed at 48- to 72-hour intervals. Range of motion in the affected joints (primarily the hand and wrist) improved from a pre-block mean of 46% to 81% of normal following the blocks. Patients also reported an 80% mean improvement in their pain. The treatment of advanced reflex sympathetic dystrophy using joint manipulation under sympatholytic Bier blocks appears to be a safe and effective method of treatment.

Arm↗

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Botany↗

Preemptive analgesia in elective surgery in patients with complex regional pain syndrome: a case report.

Complex regional pain syndrome (CRPS) can be a complication of injury or surgery or have an obscure etiology. Special precautions are indicated (i.e., preemptive analgesia) when surgery is required with a patient who has been diagnosed with CRPS. The complex case of a 44-year-old female diagnosed with reflex sympathetic dystrophy (RSD) is discussed, including current treatment options. A brief review of the literature as well as the features of complex regional pain syndrome (CRPS I/RSD and CRPS II/causalgia) are presented.

Adult↗