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Biomedical subjects

R R Young

Publications and source records attributed to R R Young.

At least 73 records · Page 4Linked to original sources

Usefulness of electrophysiological studies in the diagnosis of lumbosacral root disease.

Clinical, electrophysiological, and myelographic findings were correlated in 57 patients with the clinical diagnosis of lumbosacral root disease. Conventional motor and sensory (including sural nerve) conduction studies were normal in all patients. Electromyography, late response studies in different muscles of the lower extremity, the myelogram, or combinations of these tests were abnormal in 44 patients (77%). Of 36 patients (63%) with abnormal myelograms, 14 had normal electrophysiological studies. Twenty-nine (51%) had an abnormal electrophysiological or myelographic finding; although 8 patients in this group had a normal myelogram, 2 had an abnormal discogram and 1 an abnormal epidurogram. Electrophysiological or myelographic findings, in some cases both, correlated well with clinical signs and symptoms in 41 patients (72%). H-reflex and F response studies, when abnormal, helped in localizing a lesion in the appropriate root distribution.

Adult↗

Peripheral Nerve unmyelinated axons following lumbar sympathectomy.

One year after bilateral lumbar sympathectomy for Raynaud's syndrome, a young woman underwent fascicular biopsy of the sural nerve to help elucidate the cause of lower limb pain. The morphological features, density, and diameter spectrum of unmyelinated fibers were normal. The sympathetic nervous system appears to contribute few, if any, axons to the total population of unmyelinated axons in this cutaneous nerve.

Adult↗

Grouped spindle and electromyographic responses to abrupt wrist extension movements in man.

1. Different techniques were used to generate sudden ramp extension movements of the wrist while the subjects were either relaxed or maintaining a weak voluntary contraction in the wrist flexors. Afferent responses to the displacements were recorded with a tungsten micro-electrode inserted into a fascicle of the median nerve supplying one of the wrist flexor muscles, and e.m.g. responses were recorded with needle electrodes inserted into the same muscle.2. With the wrist flexors either relaxed or contracting, extensions at 100-200 degrees /sec for 60-70 msec (generated by either an hydraulic motor or a torque motor) produced segmented afferent responses with two to four afferent bursts, separated by intervals of 20-30 msec. The successive neural peaks, occuring during the stretch phase, were correlated to mechanical vibrations sensed by a strain gauge and sometimes also by a wrist goniometer. With the flexor muscles contracting, the successive peaks in the neurogram were followed by similar peaks in the e.m.g, the delay between neural and e.m.g. peaks being 20-25 msec.3. Small abrupt extension movements of 1-2 degrees lasting only 10-15 msec often produced segmented afferent responses with one neural burst occuring during the stretch phase and another 15-20 msec later, corresponding to a mechanical oscillatory event succeeding the stretch. The oscillation and the second neural burst were not present with small extension movements of smooth onset and halt. With the flexor muscles contracting, stimuli producing one afferent burst produced only one e.m.g. peak, whereas double-peaked afferent discharges produced double-peaked e.m.g. responses, the delay between individual neural e.m.g. peaks being 20-25 msec.4. Similar segmentation of the neural stretch responses was seen when abrupt displacements were produced by electrically induced muscle twitches, by manual pulls on a spring attached to the hand or by the subject making fast voluntary wrist extensions. This grouping of afferent discharges was seen in both multi-unit and in single-unit recordings from fibres identified as group Ia afferents.5. It is concluded that mechanical vibrations in the moving parts are initiated by abrupt joint movements and that these vibrations are sensed by the primary endings. With initial background contraction in the stretched muscles, synchronous volleys of spindle discharges produce, via segmental reflex arcs, modulation of the e.m.g. with the appearance of two or three e.m.g. peaks separated by intervals of 20-30 msec. Possible causes for the mechanical oscillations are discussed.6. For imposed movements with a duration of 60-70 msec the successive e.m.g. peaks caused a fused reflex contraction, appearing as a torque trace deflexion, starting at about the time when the movement ended and reaching its peak within about 40 msec. With longer-lasting movements the mechanical reflex response accompanying the successive e.m.g. bursts, appeared as a decelerative force, starting to oppose the ongoing movement about 60 msec after its start. Mechanical consequences of stretch reflex contractions starting after, rather than during, the stretch movement are discussed.

Action Potentials↗

Underlying mechanisms of the effects of spinal cord stimulation in motor disorders. A review of the discussion.

Possible underlying neurophysiological mechanisms of spinal cord stimulation in the modification of motor disorders were discussed by scientists working in research on motor control mechanisms. Changes of motor unit properties in upper motoneuron lesions were reviewed, the role of proprioceptive input and long-loop reflexes in motor control was discussed, analysis of ramp and ballistic movements in motor control was presented, and some aspects of neural control of locomotion were reviewed. Some physiological considerations of the influence of electrical stimulation on various neural functions were given and the conclusion was reached that, at present, no definitive models of the action of spinal cord stimulation are available.

Animals↗

Brainstem auditory and short-latency somatosensory evoked responses in brain death.

Thirty-five patients who met all clinical criteria for brain death and 53 patients who did not were tested with brainstem auditory (BAER) and short-latency somatosensory (SER) evoked responses. Of the brain-dead patients, 77% had no waves present in the BAER, including wave I, whereas 69% had medullary components present in the SER. These data suggest that the SER has greater clinical utility in the brain-death setting, because it is important to have a wave present that established that the input signal has reached the central nervous system. No brain-dead patients had subsequent waves in either test. These results are correlated with neuropathologic findings and contrasted with data obtained in the comatose but not brain-dead patients.

Adolescent↗

Sural nerve conduction studies and late responses in children undergoing hemodialysis.

Physiologic evidence of peripheral neuropathy has been described previously in children undergoing hemodialysis. In order to detect early or subclinical evidence of peripheral neuropathy, several newer electrophysiologic techniques, including latencies of late responses (H reflex and F response) and sural nerve sensory studies, were evaluated in addition to routine motor and sensory conduction in 17 randomly selected children (mean age 14.2 years) undergoing hemodialysis (12 of whom had no clinical evidence of peripheral neuropathy) and 20 age-matched normal control subjects. Conventional motor and sensory conduction studies of median and ulnar nerves and motor conduction of peroneal and tibial nerves showed abnormalities of motor conduction in 5 (29%) and abnormalities of sensory conduction in 2 (12%). Sural nerve sensory potentials were abnormal in 10 (59%) patients. Late response were significantly abnormal in 10 (59%) patients, 5 (29%) of whom had normal routine motor conduction studies in the same nerve distribution. The abnormalities of late responses and motor and sensory conduction were more evident in lower limbs. Studies of late responses and sural sensory conduction provide a method of detecting subclinical neuropathy in this patient population at a time when results of conventional motor and sensory conduction tests are within normal limits. Effects of dialysis may then be followed quantitatively in patients whose neuropathy would otherwise be undetectable.

Adolescent↗

Brainstem auditory evoked responses in 200 patients with multiple sclerosis.

Brainstem auditory evoked responses (BAERs) were recorded from 202 patients with definite, probable, or possible multiple sclerosis (MS). Definitions of abnormality were based only on interwave separations and the wave I/wave V amplitude ratio. Thirty-two percent of the patients had abnormal BAERs, and the presence of clinically unsuspected lesions was revealed by BAER abnormalities in 7.4%. Thirty-five percent of the patients who had nystagmus and 53% of those who had internuclear ophthalmoplegia at the time of testing had BAER abnormalities. Forty-five percent of the abnormalities were elicited with stimulation of one ear only, stressing the importance of monaural stimulation. Click rates faster than 10 per second did not reveal abnormalities undetected at slower rates. BAERs were normal by these criteria in patients with labyrinthine diseases and amyotrophic lateral sclerosis. Thus, the BAER in MS can (1) confirm the presence of central lesions in patients with suspected brainstem involvement, (2) document the presence of clinically unsuspected lesions, and (3) be followed over time to provide possible assistance in evaluating the effectiveness of therapeutic measures. The BAER is a useful tool in the diagnosis and management of MS.

Acoustic Stimulation↗

Segmentation of human spindle and EMG responses to sudden muscle stretch.

Grouping of the EMG response produced by quick stretches of contracting muscles has been thought to reflect 'long loop reflexes' through cerebral cortex adding to the segmental stretch reflex. Our recordings from human muscle spindle afferents responding to such stretches show that these discharges also tend to be grouped. EMG grouping may therefore be a consequence of successive segmental reflexes rather than of additional delays in long loop reflex arcs.

Animals↗

A rapid technique for the recovery of strongyloid infective larvae from pasture and soil samples.

A technique is described for the recovery of infective larvae of strongyloid nematodes from sediment resulting from the washing of pasture and soil samples. The process of recovery and counting of larvae is described by a model based on the binomial distribution. Tests of the technique have shown that it will recover approximately 50% of the larvae present in samples of pasture sediment of either 7.5 or 12.5 ml in volume after centrifugation. The efficiency of the technique was independent of the number of larvae present in samples of pasture sediment. The technique was shown to be less efficient and more variable in recovery of larvae from samples of soil sediment. Estimations in efficiency of recovery from soil sediment ranged from 64 to 110.2% and a significant effect of volume of sediment on recovery was detected.

Animals↗

The effect of temperature on times to hatching of eggs of the nematode Ostertagia circumcincta.

A delayed gamma distribution satisfactorily described the distribution of times to hatching of Ostertagia circumcincta eggs incubated in 0.1% saline at temperatures between 6 and 20 degrees C. Below 6 degree C hatching of eggs was extremely variable. The relationship between rates of development and temperature within the range 10 to 20 degrees C was more closely described by a non-linear function than a linear one. The non-linear function was incorporated into a temperature summation equation which satisfactorily predicted the hatching of eggs incubated under conditions of alternating temperatures.

Animals↗

Quantitative modelling and prediction of development times of the free-living stages of Ostertagia ostertagi under controlled and field conditions.

The development of the free-living stages of Ostertagia ostertagi incubated at constant temperatures from 5 to 27 degrees C and in dung pats in the field was observed. The death rates were adequately described by a single exponential functional and the distribution of times for development by a delayed gamma density function. The times of appearance of selected development stages such as maximum numbers of embryonated eggs and half the maximum number of infective larvae, were highly dependent on temperature. The relationships between these times and temperature were adequately described by the Arrhenius equation. The parameters of this equation and mean hourly temperature recorded in dung pats in the field were used to predict development times in the field. A comparison of predicted and observed times showed that an initial delay accounted for a large proportion of the time required for development in dung pats, particularly the embryonation of eggs. This delay was attributed to lack of aeration associated with high moisture content of the dung pat.

Animals↗

Late responses as aids to diagnosis in peripheral neuropathy.

The usefulness of performing late response studies for the detection of peripheral nerve dysfunction has been demonstrated. It has been shown that significant prolongation of the minimal latencies of the H reflex and the F response is present at a time when conventional methods of motor and sensory conduction do not show an abnormality in individual patients. Abnormalities of late responses have been shown to occur in a variety of peripheral neuropathies with "axonal" as well as "segmental demyelination" type of underlying pathology.

Adolescent↗

Physiological tremor enhanced by manoeuvres affecting the segmental stretch reflex.

In view of recent evidence that physiological tremor can be enhanced by positive feedback via the segmental stretch reflex, several manoeuvres and procedures were employed to enhance the finger and hand tremor of healthy subjects--the purpose being to determine if tremorogenic effects, at least in part, are due to increase efficacy of the stretch reflex servo. Mechanical events during tremor (and during voluntary or electrically induced muscle twitches) were recorded together with EMG activity from wrist and finger flexor muscles and discharges from primary spindle endings in these muscles. Physiological tremor can be enhanced not only by manoeuvres which increase the gain of segmental stretch reflexes (Jendrassik manoeuvre) but also by manoeuvres which increase the contrast in spindle firing during stretch versus shortening phases of tremor, thus enhancing reflex modulation. Effects of the latter type can be achieved by procedures which alter mechanical twitch properties of extrafusal fibres (isoproterenol infusions and fatigue) and by procedures which involve application of spindle stimuli acting preferentially during stretch phases of tremor movements (muscle vibrations). Physiological tremor, which can be temporarily enhanced by an externally applied muscle perturbation, also becomes accentuated by those small "pseudo-myoclonic" jerks which occur in all normal subjects attempting to perform slow, smooth movements.

Fatigue↗

Brain stem auditory evoked responses: studies of waveform variations in 50 normal human subjects.

Brain stem auditory evoked responses (BAERs) were recorded in 50 normal adult subjects at various click rates. Attention was paid to absolute latencies, interwave latencies, interear interwave latencies, absolute amplitudes, and various amplitude ratios. The variability of waves VI and VII suggests that the clinical utility of these waves is restricted-their absence is not necessarily due to a CNS lesion. The wave IV-V complex appears with six different patterns. These variations must therefore be considered normal; none should be misconstrued as indicative of disease of the CNS. Repeated studies over a period of two to nine months showed no statistically significant changes in amplitude or latency measurements with the passage of time. Knowledge of these normal values and their variations, as a precondition for establishing criteria for abnormality, is essential to the interpretation of BAERs in clinical situations.

Acoustic Stimulation↗

The effect of metrizamide on the electroencephalogram: a prospective study in 61 patients.

A prospective study was made of changes in the electroencephalogram after the use of metrizamide for myelography and posterior fossa cisternography in 61 patients (62 studies). The EEG changed in 21 patients (34%); 3 of these had had previously abnormal records, and the abnormalities were accentuated on the second recording. Eight developed paroxysmal activity, including spike and wave in 1. EEG changes appeared 24 to 48 hours after the use of metrizamide in 6 patients whose intervening EEGs were normal. The percentage of records that changed tended to increase as metrizamide was brought to more rostral levels. Symptoms following the use of metrizamide were reviewed in 58 patients. Although there were no seizures in the present series, seizures did occur with subsequent use of metrizamide in 3 other patients at our institution. Previous reports may have underestimated the frequency of EEG changes after metrizamide since these may require 24 to 48 hours to develop. The appearance of such activity suggests that the use of metrizamide in patients with known seizure disorders, the anatomical level to which metrizamide is brought during radiography, removal of contrast medium, and further investigation of premedication with anticonvulsants all require careful consideration when use of metrizamide is being contemplated.

Adult↗

Participation of the stretch reflex in human physiological tremor.

Microneurographic studies were made of normal human muscle spindle afferent activity to evaluate the role played by these endings, and by the segmental stretch reflex, in various types of physiological tremor. Primary endings are sufficiently sensitive to respond to the minute tremulous movements normally seen in contracting muscles. Human muscle spindle endings appear to possess the same non-linear sensitivity to small stretches as has been reported for cat muscle spindles. The findings also support the notion that the segmental stretch reflex plays an important role in enhanced physiological tremor, in so far as it tends to synchronize the motor outflow in such a way as to produce rhythmical contractions properly timed to reinforce the mechanical resonant properties of muscle spindle endings, the stretch reflex also serves to damp the larger oscillations of finger or hand which result from a brisk tap or muscle twitch. There is no evidence for alpha-gamma co-activation in these enhanced physiological tremors.

Afferent Pathways↗

Assessing segmental excitability after acute rostral lesions: II. The blink reflex.

Blink reflexes were obtained in a total of 34 different patients with cerebrovascular lesions; 28 were studied within 1 week of the ictus and 11 were eventually restudied. In 13, the latency of the first component of the reflex on the clinically involved side was significantly delayed (greater than 1.5 msec). This was an acute phenomenon that usually resolved within the first week after the ictus, correlated clinically with the severity of the hemiparesis and decrease in tone, and may be seen with lesions restricted to the pyramidal tract. The second component was absent in 17 of 34 patients during the early phase after stroke, and was associated with a decreased corneal response. These changes, which reflect decreased excitability of certain brainstem structures (rather than a lesion within those structures), are therefore potentially important for documenting CNS pathophysiology.

Cerebrovascular Disorders↗

The importance of studying sural nerve conduction and late responses in the evaluation of alcoholic subjects.

Motor conduction velocities of median, ulnar, peroneal, and tibial nerves and sensory conduction velocities of median and ulnar nerves were studied in 30 alcoholic subjects and a similar group of control subjects. The results were compared to sural nerve conduction velocities and late response latencies (H reflex, F response). The latter two techniques improved the diagnostic yield by 20%: Whereas 73% of our patients showed an abnormality of conduction with conventional techniques, 93% had an abnormality of sural nerve conduction, late response latencies, or both. Abnormalities of motor and sensory conduction, which were more prominent in the lower limbs than the arms, could be documented in patients who did not have any clinical evidence of peripheral neuropathy. The electrophysiologic studies performed in the present study suggest that "axonal degeneration" is the underlying pathologic process in alcoholic peripheral nerve disease.

Adult↗