Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “NUMB”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 379 records · Page 21Linked to original sources
PubMed1996

Cooperative hernia study. Pain in the postrepair patient.

BACKGROUND: The Cooperative Hernia Study assessed postoperative pain in a prospective trial as part of a larger study looking at the recurrence rate and other morbidity of the Bassini, McVay, and Shouldice repairs. METHODS: Patients were randomized to one of three surgical hernia repairs. Patients were seen in follow-up at 6, 12, and 24 months and were assessed for the presence of pain, numbness, paresthesia, and recurrence. RESULTS: Three hundred fifteen patients were seen in follow-up, with 276 seen at the 2-year mark. At 1 year, 62.9% of patients had groin or inguinal pain and 11.9% of patients had moderate to severe pain; 53.6% had pain and 10.6% of patients continued to report moderate to severe pain 2 years postoperatively. The predictors for long-term postoperative pain were as follows: absence of a visible bulge before the operation (p < 0.001); presence of numbness in the surgical area postoperatively (p < 0.05); and patient requirement of more than 4 weeks out of work postoperatively (p < 0.004). Three distinct chronic pains were identified. The most common and most severe pain was somatic, localized to the common ligamentous insertion to the public tubercle. The second was neuropathic and was referable to the ilioinguinal or genitofemoral nerve distribution. This was likely because of injury to the genitofemoral nerves, either at surgery or subsequently by encroachment of scar. The third pain was visceral, ejaculatory pain. Twenty-four percent of patients had postoperative numbness at 2 years, independent of the type of repair. Numbness was most common in the distribution of cutaneous branches of the ilioinguinal and iliohypogastric nerves. CONCLUSION: Pain or numbness are common late sequelae of traditional external surgical hernia repairs. Strategies need to be developed to reduce the risk of these complications.

Adult↗
PubMed1998

Binary sibling neuronal cell fate decisions in the Drosophila embryonic central nervous system are nonstochastic and require inscuteable-mediated asymmetry of ganglion mother cells.

Asymmetric cell division is a widespread mechanism in developing tissues that leads to the generation of cell diversity. In the embryonic central nervous system of Drosophila melanogaster, secondary precursor cells-ganglion mother cells (GMCs)-divide and produce postmitotic neurons that take on different cell fates. In this study, we show that binary fate decision of two pairs of sibling neurons is accomplished through the interplay of Notch (N) signaling and the intrinsic fate determinant Numb. We show that GMCs have apical-basal polarity and Numb localization and the orientation of division are coordinated to segregate Numb to only one sibling cell. The correct positioning of Numb and the proper orientation of division require Inscuteable (Insc). Loss of insc results in the generation of equivalent sibling cells. Our results provide evidence that sibling neuron fate decision is nonstochastic and normally depends on the presence of Numb in one of the two siblings. Moreover, our data suggest that the fate of some sibling neurons may be regulated by signals that do not require lateral interaction between the sibling cells.

Animals↗
PubMed2005

Differential expression of cell fate determinants in neurons and glial cells of adult mouse spinal cord after compression injury.

Cellular responses after spinal cord injury include activation of astrocytes, degeneration of neurons and oligodendrocytes, and reactions of the ependymal layer and meningeal cells. Because it has been suggested that tissue repair partially recapitulates morphogenesis, we have investigated the expression of several developmentally prominent molecules after spinal cord injury of adult mice where neurogenesis does not occur after injury. Cell fate determinants Numb, Notch-1, Shh and BMPs are abundantly expressed during development but mostly decline in the adult. In the present study, we investigated whether these genes are triggered by spinal cord injury as a sign of attempted recapitulation of development. Expression of Numb, Notch, Shh, BMP2/4 and Msx1/2 was analysed in the adult mouse spinal cord after compression injury by in situ hybridization up to 1 month after injury. The mRNA expression levels of Notch-1, Numb, Shh, BMP4 and Msx2 increased in the grey matter and/or white matter and in the ependyma rostral and caudal to the lesion site after injury. However, BMP2 and Msx1 were not up-regulated. Combining immunohistochemistry of cell type-specific markers with in situ hybridization we found that all the up-regulated genes were expressed in neurons. Moreover, Numb, BMP4 and Msx2 were also expressed by GFAP-positive astrocytes, while Shh was expressed by MBP-positive oligodendrocytes. In conclusion, the cell fate determinants Notch-1, Numb, Shh, BMP4 and Msx2 are expressed in neurons and/or glial cells after injury in a time-dependent manner, suggesting that these genes reflect to some extent an endogenous self-repair potential by recapitulating some features of development.

Animals↗
PubMed1997

Impotence and nerve entrapment in long distance amateur cyclists.

OBJECTIVES: To assess the frequency and duration of symptoms suggesting peripheral nerve compression after long distance cycling. MATERIAL AND METHODS: A questionnaire based cross sectional study among 260 participants in a Norwegian annual bicycle touring race of 540 km. RESULTS: Thirty-five of 160 responding males (22%) reported symptoms from the innervation area of the pudendal or cavernous nerves. Thirty-three had penile numbness or hypaesthesia after the tour. In 10, the numbness lasted for more than one week. Impotence was reported by 21 (13%) of the males. It lasted for more than one week in 11, and for more than one month in three. Both genital numbness and impotence were correlated with weakness in the hands after the ride, a complaint reported by 32 (19%) of all 169 respondents. Forty-six cyclists (30%) indicated paraesthesia or numbness in the fingers, half of them from the ulnar nerve area only. CONCLUSION: The frequency of impotence, numbness of the penis, hand weakness and sensory symptoms from the fingers in bicycle sport may be higher than hitherto recognized. It afflicts both experienced cyclists and novices. In some, the complaints may last up to eight months. Besides changing the hand and body position on the bike, restricting the training intensity, and taking ample pauses may also be necessary in prolonged and vigorous bicycle riding to prevent damage to peripheral nerves.

Athletic Injuries↗
PubMed2003

The orientation of cell division influences cell-fate choice in the developing mammalian retina.

Asymmetric segregation of cell-fate determinants during cell division plays an important part in generating cell diversity in invertebrates. We showed previously that cells in the neonatal rat retina divide at various orientations and that some dividing cells asymmetrically distribute the cell-fate determinant Numb to the two daughter cells. Here, we test the possibility that such asymmetric divisions contribute to retinal cell diversification. We have used long-term videomicroscopy of green-fluorescent-protein (GFP)-labeled retinal explants from neonatal rats to visualize the plane of cell division and follow the differentiation of the daughter cells. We found that cells that divided with a horizontal mitotic spindle, where both daughter cells should inherit Numb, tended to produce daughters that became the same cell type, whereas cells that divided with a vertical mitotic spindle, where only one daughter cell should inherit Numb, tended to produce daughters that became different. Moreover, overexpression of Numb in the dividing cells promoted the development of photoreceptor cells at the expense of interneurons and Müller glial cells. These findings indicate that the plane of cell division influences cell-fate choice in the neonatal rat retina and support the hypothesis that the asymmetric segregation of Numb normally influences some of these choices.

Animals↗
PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗
PubMed2004

[Multicenter, randomized, positive-controlled clinical study for the effects of nerotropin on diabetic neuropathy].

OBJECTIVE: To estimate the effects of Neurotropin in the treatment of neuralgia and numbness in type 2 diabetes mellitus patients with diabetic peripheral neuropathy (DPN), and compare with Methycobal. METHODS: Ninety-five patients with DPN from 4 hospitals in shanghai were randomly assigned to two groups: 49 cases in Neurotropin group (6 ml, IV, QD for 2 weeks, then, 2 tablets, BID for another 2 weeks). 46 cases in Methycobal group (1 ml, IM, QD for 2 weeks, then, 1 tablet TID for another 2 weeks. RESULTS: Neurotropin significantly improved neuralgia in type 2 diabetes mellitus with DPN, the efficacy rate was 67.3% in the first week, and 87.0% in the 4th week, comparing with 34.8% and 68.5% in the control group. The efficacy rate for numbness was 58.7% in the study group after 4 weeks therapy, and 69.5% in control group. In the whole 4 weeks therapeutic course, neuralgia and numbness were improved in the two groups, and the improved rate in Neurotropin group is high than in the control group (P < 0.01). CONCLUSION: Neurotropin had good effects in the treatment of diabetic neuralgia and numbness, the efficacy of Neurotropin in improving the senses of neuralgia is better than Methecobal., and similar with Methecobal in treating numbness.

Aged↗
PubMed1999

Prevalence of carpal tunnel syndrome in a general population.

CONTEXT: Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. OBJECTIVE: To estimate the prevalence of CTS in a general population. DESIGN: General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). SETTING: A region in southern Sweden with a population of 170000. PARTICIPANTS: A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n = 2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. MAIN OUTCOME MEASURES: Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. RESULTS: Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). CONCLUSION: Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.

Adult↗
PubMed2003

Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy.

BACKGROUND: The long-term impact of breast carcinoma and its treatment was assessed in 153 breast carcinoma survivors previously treated on a Phase III randomized trial (Cancer and Leukemia Group B [CALGB 7581]) a median of 20 years after entry to CALGB 7581. METHODS: Survivors were interviewed by telephone using the following standardized measures: Brief Symptom Inventory (BSI), PostTraumatic Stress Disorder Checklist with the trauma defined as survivors' response to having had cancer (PCL-C), Conditioned Nausea, Vomiting and Distress, European Organization for Research and Treatment of Cancer QLQ-C30 (quality of life), Life Experience Survey (stressful events), MOS Social Support Survey, comorbid conditions (Older Americans Resources and Services Questionnaire), and items developed to assess long-term breast carcinoma treatment side effects and their interference with functioning. RESULTS: Only 5% of survivors had scores that were suggestive of clinical levels of distress (BSI), 15% reported 2 or more posttraumatic stress disorder (PTSD) symptoms (PCL-C) that were moderately to extremely bothersome, 1-6% reported conditioned nausea, emesis, and distress as a consequence of sights, smells, and tastes triggered by reminders of their treatment, 29% reported sexual problems attributed to having had cancer, 39% reported lymphedema, and 33%, reported numbness. Survivors who reported greater lymphedema and numbness that interfered with functioning had significantly worse PTSD (PCL-C; P = 0.008) com- pared with survivors who reported less lymphedema and numbness. Survivors with a lower level of education (P = 0.026), less adequate social support (P = 0.0033), more severe negative life events (P = 0.0098), and greater dissatisfaction with their medical care (P = 0.037) had worse PTSD compared with other survivors. CONCLUSIONS: Twenty years after the initial treatment, the impact of breast carcinoma on survivors' adjustment was minimal. However, the higher prevalence of PTSD symptoms in response to having had cancer is indicative of continuing psychologic sequelae long after treatment completion. Findings related to lymphedema and numbness and continued symptoms of PTSD suggest that the long-term psychologic and medical sequelae on adjustment may be underrecognized. To establish in more detail whether survivors' overall psychologic state is any different from that of individuals without cancer, a population of community residents without cancer would need to be studied.

Adaptation, Psychological↗
PubMed2006

Role of distinct PTSD symptoms in intimate partner reabuse: a prospective study.

This prospective study examines the impact of four posttraumatic stress disorder (PTSD) symptom clusters (hyperarousal, reexperiencing, numbing, and avoidance) on reabuse over 1 year among women exposed to intimate partner violence (IPV). The covariates include severity of IPV, a history of childhood violence, and characteristics of the abusive relationship. Although both hyperarousal and numbing symptoms were higher at baseline among women subsequently reabused, only numbing symptoms increased the odds of reabuse after controlling for the covariates. Greater IPV severity and shorter relationship duration also increased the risk of reabuse. Results indicate that specific symptoms of PTSD, especially numbing, need to be addressed to increase the safety of women seeking services for IPV.

Adult↗
PubMed2000

Multiple signalling pathways establish cell fate and cell number in Drosophila malpighian tubules.

A unique cell, the tip mother cell, arises in the primordium of each Drosophila Malpighian tubule by lateral inhibition within a cluster of achaete-expressing cells. This cell maintains achaete expression and divides to produce daughters of equivalent potential, of which only one, the tip cell, adopts the primary fate and continues to express achaete, while in the other, the sibling cell, achaete expression is lost (M. Hoch et al., 1994, Development 120, 3439-3450). In this paper we chart the mechanisms by which achaete expression is differentially maintained in the tip cell lineage to stabilise cell fate. First, wingless is required to maintain the expression of achaete in the tubule primordium so that wingless mutants lack tip cells. Conversely, increasing wingless expression results in the persistence of achaete expression in the cell cluster. Second, Notch signalling is restricted by the asymmetric segregation of Numb, as the tip mother cell divides, so that achaete expression is maintained only in the tip cell. In embryos mutant for Notch tip cells segregate at the expense of sibling cells, whereas in numb neither daughter cell adopts the tip cell fate resulting in tubules with two sibling cells. Conversely, when numb is overexpressed two tip cells segregate and tubules have no sibling cells. Analysis of cell proliferation in the developing tubules of embryos lacking Wingless after the critical period for tip cell allocation reveals an additional requirement for wingless for the promotion of cell division. In contrast, alteration in the expression of numb has no effect on the final tubule cell number.

Animals↗
PubMed1994

Prevalence of Raynaud's phenomenon in different groups of workers operating hand-held vibrating tools.

In eight groups of subjects operating various hand-held vibrating tools and aged from 30 to 59 years, the prevalence rates of vibration-induced white finger (VWF) and numbness, pain, or stiffness in the upper and lower extremities were investigated. Hand-transmitted vibration levels (HTVLs) were measured on the back of the hand, by means of unidirectional (x-axis) vibration dosimeters, and the frequency-weighted acceleration levels [(Lh,w)eq,t] were determined as the vibration levels. The prevalence rates of VWF and numbness of the hands in these subjects were compared to the prevalence rates of Raynaud's phenomenon (RP) and numbness of the hands in 1027 males and 1301 females not occupationally exposed to vibration (age range: 30-59 years). It was observed that in subjects exposed to HTVLs of between 1.1 and 2.5 m/s2, the prevalence of VWF was between 0.0% and 4.8%. The prevalence of VWF reached 9.6% in a group of workers exposed to HTVLs of 2.7-5.1 m/s2. The latter group showed a significant difference (P < 0.05) in the prevalence of VWF compared to the 2.7% prevalence of RP in male subjects of the general population. The prevalence of VWF in female subjects exposed to vibration (4.3%) was not significantly different from the prevalence of RP in females of the general population (3.4%). The prevalence rates of numbness of the hands were in the range of 6.5%-30.4% in the exposed groups and in the range of 13.4%-29.5% in the general population. Among the subjective symptoms, only VWF showed a significant positive correlation with HTVLs (R2 = 0.5, P < 0.05). It was concluded that in decisions concerning quantitative recommendations for vibration exposure, the prevalence of VWF should be employed. With a view to decreasing the risk of developing VWF, estimated vibration safety values for 4 h and 2 h daily exposures are discussed.

Adult↗
PubMed1998

Comparison of electrophysiologic and autonomic tests in sensory diabetic neuropathy.

We examined autonomic function in 46 patients with symmetric sensory non-insulin dependent diabetic neuropathy without autonomic symptoms and 31 age-matched control patients using the composite autonomic scoring scale (CASS) and electrophysiologic examination. The patients were divided into three groups by subjective severity of pain or numbness; 17 had slight pain or numbness, 15 had mild pain or numbness, and 14 had moderate pain or numbness. The patients in the moderate group had the following: a mild reduction in systolic and mean blood pressure (BP) within 1 minute of head-up tilt and a partial recovery after 5 minutes; an excessive fall in early phase II (IIe), an absence of late phase II (IIl) and reduced phase IV beat-to-beat BP responses to Valsalva maneuver (VM); a poor heart rate response to deep breathing; a reduced quantitative sudomotor axon reflex test (QSART) response in distal leg and foot; the highest CASS among the 3 groups; and reduced conduction velocity and amplitude in post-tibial nerve and sural nerve. The mild group had a mild reduction in BP during phase IIe and an absent phase IIl but normal phase IV overshoot during VM; a reduced QSART in the foot; a CASS between the moderate and slight groups; and reduced conduction velocity and amplitude in post-tibial nerve and reduced amplitude in sural nerve. The slight pain group had no abnormalities except for mild cardiovagal dysfunction. CASS gathered from all cases had a significant correlation with amplitude of sural nerve. These results suggest that the patients with symmetric sensory diabetic neuropathy may also have autonomic dysfunction, although they did not have any obvious autonomic symptoms, and that abnormalities in autonomic function parallel changes in somatic function in peripheral nerve. The CASS may be a sensitive tool, similar to the neurophysiologic test, for assessing diabetic neuropathy.

Autonomic Nervous System↗
PubMed1996

The role of pain from veins for the formation of perivenous edema in humans.

To test the hypothesis that nociception from veins plays a role in the formation of perivenous edema, we looked at edema along hand veins of humans during painful noxious stimulation in the presence and absence of nerve conduction block. Pain from vascularly isolated hand vein segments was evoked by perfusion with hyperosmolar saline and rated with the help of an electronically controlled visual analogue scale. Perivenous edema measured as changes in skin altitude was continuously recorded by means of infrared reflection. To alternately block the innervation of skin and vein segment we used a perivenous block (vein but not skin numbed), a distal ulnar nerve block (skin but not vein numbed), and a proximal ulnar nerve block (both vein and skin numbed). Without nerve block, hyperosmolar saline always evoked both pain and a continuous increase in perivenous edema to a maximum of 2.0-3.2 mm after 30 min. On painless control perfusions with isoosmolar saline, edema increased slightly (0.2-0.8 mm) to a plateau which was maintained until the end of perfusion. When the vein was denervated by perivenous or proximal ulnar nerve block, hyperosmolar saline evoked a slight increase in edema which resembled that of control perfusions in both extent and time course. On distal ulnar nerve block, which numbed the skin but not the vein, both pain and substantial edema were evoked. These observations show that nociception from veins is a prerequisite for perivenous edema to occur.

Adult↗
PubMed1987

Clinical experience with the use of peripheral vasodilator in oral disorders.

Conventional therapies practised in the treatment of asymptomatic neuralgia, oral submucous fibrosis and paraesthesic numbness, are empirical and symptomatic in nature. These are usually prolonged and may be inadequate, impractical with complete or incomplete remissions associated with or without relapses. High dosages of drugs administered for longer duration, are also not infrequently without side-effects. With these problems in view, the clinical use of nylidrin hydrochloride a peripheral vasodilator, was experienced for over 10 years. Irrespective of age, sex and status, 97 cases were randomly extracted from the hospital and oral surgery clinical records. The projected sample included 33 cases of asymptomatic neuralgia, 58 cases of oral submucous fibrosis and 6 cases of numbness. Neuralgia, where mean age was 50 years, was treated with nylidrin hydrochloride, vitamin B-complex and carbamazepine. Oral submucous fibrosis where mean age was 38 years, was treated with nylidrin hydrochloride, vitamins A,E,B-complex, iodine, placental extract, local and systemic corticosteroids and physiotherapy. Paraesthesic numbness, following iatrogenic or accidental trauma to the affected nerve, was treated with nylidrin hydrochloride and B-complex therapy. Peripheral vasodilator administered in all 97 cases, initially contained low divided doses, which steadily were increased or decreased as per individual response. There were reportedly no side-effects, except complaints of flushingly warm skin. Supportive therapy with antibacterials, tranquilizers and analgesics, along with minor dental surgery, were given as and when required. The success rate was 72.16% in total, while individually it varied from 84.85% in neuralgia, 62.07% in oral submucous fibrosis and 100% in numbness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Neural cell fate in rca1 and cycA mutants: the roles of intrinsic and extrinsic factors in asymmetric division in the Drosophila central nervous system.

In the central nervous system (CNS) of Drosophila embryos lacking regulator of cyclin A (rca1) or cyclin A, we observe that several ganglion mother cells (GMCs) fail to divide. Whereas GMCs normally produce two sibling neurons that acquire different fates ('A/B'), non-dividing GMCs differentiate exclusively in the manner of one of their progeny ('B'). In zygotic numb mutants, sibling neuron fate alterations ('A/B' to 'A/A') occur infrequently or do not occur in some sibling pairs; we have determined that depletion of both maternal and zygotic numb causes sibling neurons to acquire equalized fates ('A/A') with near-complete expressivity. In rca1, numb mutant embryos, we observe binary cell fate changes ('B' to 'A') in several GMCs as well. Finally, we have demonstrated that expression of Delta in the mesoderm is sufficient to attain both sibling fates. Our results indicate that the intrinsic determinant Numb is absolutely required to attain differential sibling neuron fates. While the extrinsic factors Notch and Delta are also required to attain both fates, our results indicate that Delta signal can be received from outside the sibling pair.

Animals↗
PubMed2002

Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection.

STUDY OBJECTIVE: To evaluate pain and the spread of analgesia when local anesthetics are given as an intradermal injection into the dorsal aspect of the hand. DESIGN: Randomized, double-blinded, placebo-controlled study. SETTING: University medical center. PATIENTS: 40 consenting adult volunteers. INTERVENTIONS: Volunteers were randomly assigned to receive a 0.25-mL injection of either lidocaine hydrochloride (1%), buffered lidocaine, diphenhydramine (1%), or placebo (0.9% sodium chloride solution) into the dorsal aspect of both hands. MEASUREMENTS: The volunteers used a visual analog scale to compare the pain of needle insertion and solution injection. Then at 1, 2, 5, 10, 20, and 30 minutes after intradermal injection, the extent of the analgesic area was marked on a strip of tape placed horizontally across the hand. Then at 32 minutes after intradermal injection, the extent of the analgesic area was marked on a strip of tape placed vertically across the hand. The volunteers were called each day and asked the duration of their numbness or hyperesthesia until their hands were no longer numb or sore. MAIN RESULTS: Buffered lidocaine during intradermal infiltration was found to be significantly (p < 0.05) less painful than either lidocaine hydrochloride or diphenhydramine and equivalent to placebo. Diphenhydramine and lidocaine hydrochloride during intradermal infiltration induced significantly (p < 0.05) more pain than buffered lidocaine or placebo. Lidocaine hydrochloride displayed a significantly (p < 0.05) larger diameter of analgesia than placebo by 1 minute after the injection, buffered lidocaine by 2 minutes after injection, and diphenhydramine by 5 minutes after injection. By 20 minutes after injection, diphenhydramine diameter of analgesia was significantly (p < 0.05) larger than placebo but significantly less than buffered lidocaine. By 30 minutes after injection, diphenhydramine diameter of analgesia was equivalent to placebo whereas buffered lidocaine and lidocaine diameters were still significantly (p < 0.05) larger than placebo. Diphenhydramine injection resulted in numbness that lasted significantly (p < 0.05) longer than other study solutions whereas buffered lidocaine and lidocaine injections resulted in numbness that lasted significantly longer than placebo. Diphenhydramine injection resulted in hyperesthesia that lasted for 2 or more days in 12 of the volunteers. CONCLUSION: There is a reduction of infiltration pain using buffered lidocaine as opposed to lidocaine and diphenhydramine. Although lidocaine injection resulted in a slightly faster spread of analgesic diameter, buffered lidocaine was equivalent to lidocaine from minute 2 until minute 30. Therefore, to obtain optimal anesthetic conditions, we recommend that buffered lidocaine be given 2 minutes before performing catheterization, whereas diphenhydramine should be given 5 minutes before catheterization, but only when buffered lidocaine cannot be used.

Adult↗
PubMedDate not supplied

Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis.

BACKGROUND CONTEXT: Multilevel fenestration or laminectomy is generally performed to treat the patient with lumbar canal stenosis (LCS). However, in patients requiring laminectomy, little attention has been paid to the later development of lumbar pain possibly caused by a removal of the posterior elements of the spine. In general, spinal instrumentation and fusion has been generally performed when laminectomy might cause severe postoperative spinal instability. Surgical methods where osteotomized vertebral arches are repositioned rather than removed have long been performed. However, they have never become widespread, possibly because of the complicated surgical procedures and poor postoperative arch stability, which leads to a long period of postoperative immobilization. PURPOSE: The purpose of the present report was to introduce our surgical procedures of spinal canal enlargement using restorative laminoplasty and to report the results. STUDY DESIGN/SETTING: This retrospective study was conducted to analyze the clinical results in 33 patients with lumbar canal stenosis who had been treated by our surgical procedures of spinal canal enlargement using restorative laminoplasty. PATIENT SAMPLE: Subjects were 33 patients followed for at least 2 years after surgery. Meyerding Grade I degenerative spondylolisthesis was found in 10 patients, and degenerative scoliosis of more than 5 degrees was seen in 20 patients. Nine patients demonstrated both degenerative spondylolisthesis and degenerative scoliosis. OUTCOME MEASURES: Using the Japanese Orthopedic Association (JOA) scoring system, lumbago, sciatica, leg numbness, muscle strength and gait were quantified before surgery, 1 year after surgery and at final examination (at least 2 years after surgery) to calculate improvement rates. Furthermore, correlations to age, gender, disease duration, degenerative spondylolisthesis and degenerative scoliosis were statistically analyzed. METHODS: Our surgical procedures of spinal canal enlargement using restorative laminoplasty were performed for all patients. In our procedures, posterior elements were reapplied with an absorbable fixation (poli-L-lactic acid pins). No other fusion procedure was performed jointly. RESULTS: The mean number of restored vertebral arches was 2.2, and mean surgery time was 131 minutes. Mean volume bleeding during surgery was 328.0 ml. In all patients, successful bone healing was obtained at a mean of 5 months after surgery. Mean improvement rate for the total JOA score was 80.6%. Mean improvement rates for lumbago and sciatica were 70.0% and 87.7%, respectively. Mean improvement rate for leg numbness was 50.8%. Mean improvement rates for leg muscle strength and intermittent claudication were 70.0% and 98.9%, respectively. No significant correlation was found between gender and overall improvement rate, between age and overall improvement rate, between age and leg numbness or between number of restored vertebral arches and overall improvement rate. The tendency was that the longer the disease duration, the lower the overall improvement rate, and the more severe the residual numbness. No significant correlation was found between disease duration and muscle strength or lumbago.A significant correlation was not found between the presence of preoperative Grade I degenerative spondylolisthesis and overall improvement rate or lumbago. However, a significant difference in severity of lumbago existed between patients with degenerative scoliosis of 9 degrees and below and those with degenerative scoliosis of 10 degrees and above. CONCLUSIONS: Our surgical procedures of spinal canal enlargement using restorative laminoplasty produce complete decompression and anatomical reconstruction of the posterior elements, ligaments and muscles. Improvement in complaints of lumbago may be a consequence of the anatomical reconstruction of the posterior spinal elements. Overall, favorable results were obtained. The best results were obtained if surgery is performed within 2 years of the onset of LCS.

Aged↗