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PubMed1986

Analysis of CSF dynamics by computerized pressure-elastance resorption test in hydrocephalic children. Indications for surgery.

Since 1982, 23 hydrocephalic children have been studied for compensatory mechanisms of the cerebrospinal fluid system. The authors describe the method and results of a computerized pressure-elastance resorption test (CPERT), a spinal steady-state infusion test, in hydrocephalic children. Computerized analysis of the P/V and AMP/P curve provides valuable data that precisely describe the degree of disturbances of CSF dynamics. The following parameters were quantitatively determined: out-flow resistance, opening pressure, elastance, elasticity, reference pressure and optimum (break-point) pressure. It is concluded that the described test allows the differential diagnosis of chronic hydrocephalus in children. The value of optimum pressure (analysis of AMP-P relation) gives precise indications for surgery and the selection of a valve system with adequate opening pressure. In some cases, the CPERT test can be used instead of continuous ICP monitoring.

Adolescent↗
PubMed1997

The effects of nerve growth factor and anti-nerve growth factor antibody on the neuroendocrine reproductive system in the European starling Sturnus vulgaris.

Thyroidectomy of starlings causes them to remain in breeding condition indefinitely; deactivation of gonadotrophin-releasing hormone neurons that is characteristic of photorefractoriness does not occur. We hypothesise that a neurotrophin, whose presence or ability to function is dependent upon thyroid hormones, is somehow involved in this termination of gonadotrophin-releasing hormone release. Nerve growth factor is one such candidate. Mouse 7S-nerve growth factor dissolved in artificial cerebro-spinal fluid was therefore infused into the lateral ventricle of thyroidectomised male starlings held on long days four times daily for 21 days and 31 days, in separate experiments, to see if photorefractoriness would occur. The result was significant gonadal regression in the treatment groups during the infusion period, with no change in testicular volume in the control groups. Testicular recrudescence occurred after the end of the treatment period. To see if this was a non-specific effect, or progression towards photorefractoriness per se, we used castrated, photorefractory starlings held on long days. Anti-nerve growth factor antibody was infused into the lateral ventricle at increasing concentrations and frequency. There was a significant rise in circulating luteinising hormone levels in the treatment groups as compared to controls, increasing with antibody dosage.

Animals↗
PubMed2005

Combined spinal-propofol anesthesia with noninvasive positive-pressure ventilation.

Twenty-three adult patients undergoing repair of inguinal hernia under spinal anesthesia received propofol infusion for sedation with the assist of noninvasive positive-pressure ventilation (NPPV). Circulatory and respiratory parameters, such as percutaneous oxygen saturation, transcutaneous carbon dioxide tension, respiratory rate, tidal volume, blood pressure, and heart rate, were maintained within physiological ranges during the anesthesia. There were no adverse effects. These findings suggest that the application of NPPV in patients receiving propofol infusion for sedation is clinically practicable during anesthesia.

Adult↗
PubMedDate not supplied

A simple treatment of post-lumbar-puncture headache.

We report a case of post-lumbar-puncture headache successfully treated with intravenous caffeine sodium benzoate. The patient presented to the emergency department with a severe headache three days after a myelogram of the lumbar region. Caffeine sodium benzoate (500 mg) in 1 liter of fluid (D5LR) intravenously over one and a half hours was administered. The patient reported complete resolution of symptoms and no recurrence of headache. Caffeine sodium benzoate is a simple treatment of post-lumbar-puncture headaches. It should be considered as a safe alternative to an epidural blood patch for the treatment of post-lumbar-puncture headaches.

Adult↗
PubMed2000

Radiofrequency ablation of rabbit kidney using liquid electrode: acute and chronic observations.

BACKGROUND AND PURPOSE: The percentage of small renal tumors being diagnosed has increased at least five-fold in the last 20 years. The question of how best to treat these lesions remains unanswered. We studied the effectiveness of "wet" radiofrequency (RF) ablation of renal tissue. MATERIALS AND METHODS: New Zealand white rabbits (N = 48) underwent a 1- or 2-minute ablation of renal parenchyma with a modified insulated spinal needle capable of infusing saline, measuring temperature and impedance, and delivering RF energy. Animals were followed and examined up to 54 days after surgery. RESULTS: All animals survived for the planned period. Intravenous urograms showed no fistula or urinoma formation and confirmed continued function of the remaining parenchyma. The 1-minute treatments consistently ablated 20% to 25% (average 7 cm) of the tissue, whereas the 2-minute treatments ablated 34% to 36% (average 10 cm). Acutely, there was coagulative necrosis and infiltration of inflammatory cells. Chronically, there were well-demarcated lesions with complete effacement of the tubular epithelium and destruction of the glomeruli. CONCLUSION: Wet radiofrequency ablation with a liquid electrode can reproducibly create large lesions safely and quickly. The technique may soon become an alternative, minimally invasive therapy for small renal tumors.

Animals↗
PubMed1999

Functional recovery after central infusion of alpha-melanocyte-stimulating hormone in rats with spinal cord contusion injury.

Melanocortins, peptides related to alpha-melanocortin-stimulating hormone (alpha MSH) and adrenocorticotropic hormone (ACTH), are known to improve axonal regeneration following peripheral nerve injury and stimulate neurite outgrowth from central nervous system (CNS) neurons both in vitro and in vivo. The neurite outgrowth promoting capacity of alpha MSH has prompted us to investigate the effects of intrathecal application of alpha MSH on functional and electrophysiological recovery in a well-characterized model of spinal cord contusion injury. Different doses of alpha MSH were applied via osmotic minipumps into the cisterna magna for 10 days, thereby delivering the peptide directly into the CNS. Functional recovery was monitored during 8 postoperative weeks by means of the Basso, Beattie, and Bresnahan locomotor rating scale, and the thoracolumbar height test. At the end of the study, electrophysiological analysis of rubrospinal motor evoked potentials as performed. Our data showed that application of 3.75 micrograms/kg/h alpha MSH resulted in a marked functional recovery, accompanied by a decrease in the latency of the rMEP. This study demonstrates that intrathecal application of alpha MSH results in functional recovery after spinal cord contusion injury. These findings may initiate new treatment strategies and/or the use of melanocortins in human spinal cord injury.

Analysis of Variance↗
PubMed1996

Postoperative epidural opioid analgesia: what are the choices?

The administration of hydrophilic opioids via a continuous infusion results in selective spinal analgesia with a low incidence of side effects. Lipophilic opioids may also be associated with spinal effects. However, the doses required to produce postoperative analgesia also produce plasma concentrations within the MEAC. Thus, in clinical practice it may not be possible to limit epidural doses of lipophilic opioids to those associated with spinal analgesia. Regardless of the mechanism of action, epidural administration of lipophilic opioids may offer no clinical advantages over the IV route. Notwithstanding, epidural administration of small doses of lipophilic opioids in combination with local anesthetics may offer significant clinical advantages over systemic administration of opioids alone. Dose-ranging studies will be necessary to determine the ideal concentrations of opioids and local anesthetics, as well as the ratios of the two drugs to obtain optimal analgesia with minimal incidence of side effects.

Analgesia, Epidural↗
PubMed1980

Control of blood flow in a large surface wound.

To study the factors which control the increased blood flow to a large granulating wound, Doppler flow probes were implanted around the external iliac arteries bilaterally in 20-40 kg goats. Following operative recovery and basal measurements, skin was excised from one hind limb. Blood flow in the injured leg of five awake, resting goats rose above that of the uninjured leg by the fourth postoperative day and plateaued at 70-90% above uninjured leg flows for the next two weeks. The increase in injured leg blood flow was associated in time with the formation of a highly vascularized wound. This increased blood flow to the injured leg persisted in 11 anesthetized goats studied 9-12 days postinjury (186 +/- 27 ml/minute versus 107 +/- 19, p < 0.01, mean +/- SEM). Substrate turnover revealed that elevated blood flow to the injured leg was not the result of increased oxygen consumption, but was associated with increased glucose uptake (7.8 +/- 1.1 mg/minute versus 2.7 +/- 0.6, p < 0.001) and lactate release (3.6 +/- 1.3 mg/minute versus 1.1 +/- 0.7, p < 0.05). Limitations in oxygen delivery failed to explain the increased blood flow to the injured leg, since raising arterial PO(2) or exposing the leg to a high oxygen environment had no effect on limb perfusion. Although lactate and potassium, both potential vasodilators, were elevated in the femoral vein blood from the injured leg, a series of cross perfusion studies failed to reduce vascular resistance in another leg on the same or a second uninjured animal. Additional studies revealed that changes in leg vascular resistance were markedly diminished in the injured leg following hemorrhage, spinal anesthesia, or intravenous infusion of epinephrine or norepinephrine. These studies of large granulating wounds reveal: 1) elevated injured leg flow is not the result of local hypoxia; 2) any wound vasodilators have no impact on systemic circulation; 3) the wound vasculature appears relatively insensitive to circulating and neurogenic vasomotor drives.

Animals↗
PubMed1990

Effects of the alpha 2-adrenoceptor agonist UK14304 on pressor responses in pithed rats.

1. Intravenous infusions of UK14304 (0.3-10 micrograms/kg per min) in pithed rat produced dose-dependent pressor responses which were not affected by prazosin (10 micrograms/kg) but were reduced by yohimbine (0.3 mg/kg). 2. Pressor responses to noradrenaline (0.1 micrograms/kg), phenylephrine (1 micrograms/kg) and vasopressin (10 mU/kg) were enhanced during infusions of UK14304 (0.03-1 micrograms/kg per min). Likewise, pressor responses to spinal sympathetic stimulation were enhanced during infusions of low concentrations of UK14304 (0.03-0.3 microgram/kg per min) but were reduced during infusion of a higher concentration of UK14304 (10 micrograms/kg per min). 3. After administration of yohimbine (0.3 mg/kg) or the calcium channel blocking drug diltiazem (infused at 50 micrograms/kg per min), pressor responses to noradrenaline and UK14304 were reduced, and responses to noradrenaline during infusion of UK14304 were not enhanced. 4. Prazosin (10 micrograms/kg) revealed a secondary depressor component in the response to sympathetic stimulation which is due to beta-adrenoceptor activation, since it was abolished by ICI 118551 (0.3 mg/kg). In the presence of ICI 118551 plus prazosin, pressor responses to sympathetic stimulation were enhanced during infusions of UK14304. 5. The depressor response to nitroprusside and the depressor component of responses to sympathetic stimulation after prazosin were enhanced during infusions of UK14304 at concentrations that increased the blood pressure. 6. The findings show that alpha 2-adrenoceptor activation enhanced the pressor responses to sympathetic nerve stimulation, noradrenaline, phenylephrine and vasopressin in the pithed rat and beta-adrenoceptor activation produced depressor responses which increased with increasing blood pressure.

Adrenergic alpha-Agonists↗
PubMed1994

Hypoxic reperfusion after ischemia in swine does not improve acute brain recovery.

We tested the hypothesis that transient hypoxic reperfusion after 15 min of global cerebral ischemia would improve acute recovery of electrical function. We also determined the changes in cerebral blood flow (CBF) and cerebral oxygen consumption (CMRO2) during transient hypoxic reperfusion. Pentobarbital-anesthetized pigs were exposed to cerebral ischemia by raising intracranial pressure to 100 mmHg above arterial pressure with rapid infusion of artificial cerebral spinal fluid into a lateral ventricle. During the reperfusion period, normoxia was maintained at an arterial oxygen partial pressure (PaO2) of 80-120 mmHg for 120 min of reperfusion and hypoxia at a PaO2 of 35-45 mmHg for the first 30 min of reperfusion in another group. The postischemic hypoxia group showed persistent elevation in microsphere-determined CBF at 30 min of reperfusion in all brain regions and lack of delayed hypoperfusion through 120 min of reperfusion. The normoxic group demonstrated transient postischemic hyperemia and hypoperfusion. CMRO2 was not significantly different between groups at any time point. In both groups, the somatosensory-evoked potential amplitude reached only 10% recovery by the end of 120 min of reperfusion. We conclude that hypoxemia during reperfusion after cerebral ischemia in this model does not improve acute brain electrical function and prolongs postischemic hyperemia.

Animals↗
PubMed2000

Perfusion of the mechanically compressed lumbar ganglion with lidocaine reduces mechanical hyperalgesia and allodynia in the rat.

The rat L(5) dorsal root ganglion (DRG) was chronically compressed by inserting a hollow perforated rod into the intervertebral foramen. The DRG was constantly perfused through the hollow rod with either lidocaine or normal saline delivered by a subcutaneous osmotic pump. Behavioral evidence for neuropathic pain after DRG compression involved measuring the incidence of hindlimb withdrawals to both punctate indentations of the hind paw with mechanical probes exerting different bending forces (hyperalgesia) and to light stroking of the hind paw with a cotton wisp (tactile allodynia). Behavioral results showed that for saline-treated control rats: the withdrawal thresholds for the ipsilateral and contralateral paws to mechanical stimuli decreased significantly after surgery and the incidence of foot withdrawal to light stroking significantly increased on both ipsilateral and contralateral hind paws. Local perfusion of the compressed DRG with 2% lidocaine for 7 days at a low flow-rate (1 microl/h), or for 1 day at a high flow-rate (8 microl/h) partially reduced the decrease in the withdrawal thresholds on the ipsilateral foot but did not affect the contralateral foot. The incidence of foot withdrawal in response to light stroking with a cotton wisp decreased significantly on the ipsilateral foot and was completely abolished on the contralateral foot in the lidocaine treatment groups. This study demonstrated that compression of the L(5) DRG induced a central pain syndrome that included bilateral mechanical hyperalgesia and tactile allodynia. Results also suggest that a lidocaine block, or a reduction in abnormal activity from the compressed ganglia to the spinal cord, could partially reduce mechanical hyperalgesia and tactile allodynia.

Anesthetics, Local↗
PubMed2001

Intrathecal chemotherapy with antineoplastic agents in children.

Intrathecal chemotherapy with antineoplastic agents is mainly utilised in children with leukaemia and lymphoma, and in selected brain tumours. In these diseases, intrathecal use is restricted to methotrexate (MTX), cytosine arabinoside (Ara-C) and corticosteroids. A number of other agents are, at the present time, under evaluation. Intrathecal MTX administered sequentially with systemic high dose MTX infusion prolongs therapeutic cerebral spinal fluid (CSF) levels of the drug. Prolonged therapeutic CSF levels can also be achieved by giving repeated small intrathecal doses of MTX over an extended period in selected patients, with an implanted Ommaya reservoir. In the CSF, the metabolic inactivation of Ara-C is significantly lower than in plasma with a CSF clearance similar to the rate of CSF bulk flow. A slow-release formulation of Ara-C may be given intrathecally, resulting in a prolonged cytotoxic concentration in the CSF. CNS relapse and neurotoxicity in patients with acute lymphoblastic leukaemia, especially younger children, may be reduced by using age-related dosing of intrathecal MTX and Ara-C. Hydrocortisone is used in combination with MTX and Ara-C for so-called 'triple intrathecal chemotherapy' in the treatment of meningeal leukaemia. Intrathecal thiotepa does not appear to be advantageous over systemic administration in patients with brain and meningeal leukaemia. Monoclonal antibodies, reactive with tumour-associated antigens, can be used as delivery systems for chemotherapeutic agents and radionuclides. However, the development of this new approach is currently under evaluation in larger clinical studies. Neurological adverse effects may be expected with intrathecal chemotherapy and are increased by high dose systemic therapy, concomitant cranial radiotherapy or meningeal infiltration by neoplastic cells. Inadvertant intrathecal administration of antineoplastic agents that are indicated for systemic administration only, is dangerous and may result in a fatal outcome.

Adrenal Cortex Hormones↗
PubMed2000

Brown tumor of the spine revealing secondary hyperparathyroidism. Report of a case.

Brown tumors are classic skeletal manifestations of hyperparathyroidism usually seen in severe forms with subperiosteal bone resorption. They are exceedingly rare at the spine. We report the case of a woman on hemodialysis who developed two brown tumors, including one at the spine, as the first manifestations of secondary hyperparathyroidism. There were no neurologic manifestations. The clinical and radiologic abnormalities resolved after parathyroidectomy preceded by a bisphosphonate infusion to prevent possible spinal lysis progression during the immediate postoperative period. In addition to the location of one of the brown tumors at the spine, unusual features in this case were the explosive onset of hyperparathyroidism and the absence of detectable subperiosteal resorption. We also suggest that bisphosphonate therapy given before parathyroidectomy may be useful in patients with spinal brown tumors.

Female↗
PubMed2003

[Quantitative analysis of motoneurons innervating the muscle levator ani in rats with anorectal malformation].

OBJECTIVE: To quantify the motorneurons innervating the muscle levator ani (rat equivalent of puborectalis in human) by retrograde tract-tracing in a rat model of anorectal malformation. METHODS: Anorectal malformation is induced in fetuses by gavage feeding of ethylenethiourea (ETU; 125 mg/kg body weigh) to pregnant outbreed Wistar rats at day 11 of gestation. At E20, fetal surgery was performed to expose the muscle levator ani and fluorogold (FG) was injected. Fetuses were collected 24 hours later, fixed by paraformaldehyde infusion cardially. The lumbosacral spinal cord was removed for cryosection. Serial longitudinal sections (60 micro m) encompassing the whole width of lumbosacral spinal cord were studied with fluorescent microscopy. The number of FG-labelled motoneurons were scored and compared between fetuses with or without malformation in the ETU-injection group, and normal controls. RESULTS: In the ETU-injection group, 55.6% (95/171) of fetuses displayed anorectal malformation, 56.7% of fetuses displayed anomalies of neural tube. FG was injected to the muscle levator ani of 8 fetuses without defects of anorectum or neural tube, 5 fetuses with imperforate anus only, 10 fetuses with anomalies of neural tube, and 15 fetuses with combined imperforate anus and anomalies of neural tube. Fetuses (n = 9) from non-injected with ETU group were injected with FG as normal controls. The total number of FG-labelled motoneurons in the fetuses without defects of anorectum and neural tube, with imperforate anus, with anomalies of neural tube, with combined imperforate anus and anomalies of neural tube, and normal controls were 109 +/- 38, 55 +/- 26, 48 +/- 30, 54 +/- 29 and 135 +/- 29 respectively. FG-labelled motoneurons in the fetuses with imperforate anus, anomalies of neural tube, and combined imperforate anus and anomalies of neural tube are significantly fewer than that in fetuses without defects of anorectum or neural tube (P < 0.05), and in normal controls (P < 0.005). The number of FG-labelled motoneurons did not differ between the fetuses without defects of anorectum or neural tube and normal controls (P > 0.05). CONCLUSION: Fewer motoneurons that innervates the puborectalis may contribute to the poor postoperative anorectal function in patients with anorectal malformation.

Abnormalities, Multiple↗