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Successful management of bladder function mandates a thorough knowledge of the neuroanatomy and physiology of micturition. Accurate urodynamic diagnosis of the exact vesicourethral dysfunction is a key to successful management. The primary concern for the urologist is preservation of renal function, taking into account the social needs of the patient.
Gene transfer is a potential means of treating chronic neurologic disorders and injury related neural degeneration. One approach for transferring genes to the CNS is to genetically modify cells in vitro and then transplant the cells to the CNS. For example, fibroblasts can be infected with a replication-defective retrovirus expressing a transgene, and can then be transplanted into the brain or spinal cord, thereby providing neurotrophic factors and substrates for axonal growth and elongation. In this review we discuss the grafting of neurotrophic factor secreting autologous fibroblasts in the rat and primate CNS. NGF secreting grafts have been shown to prevent degeneration of cholinergic neurons in the basal forebrain of primates and to induce sprouting of sensory, motor, and noradrenergic neurites after spinal cord injury. These results suggest the potential usefulness of ex vivo gene transfer for the treatment of Alzheimer's disease and spinal cord injury.
Patients with a variety of neuromuscular diseases including quadraplegia due to high spinal cord lesions can be managed with full-time noninvasive ventilation instead of intermittent positive pressure ventilation (IPPV) via a tracheostomy. This approach is not suitable for patients with severe bulbar involvement. To be successful with full-time noninvasive IPPV, the ventilator user must realize three goals. First, respiratory system compliance should be optimized and maintained by frequent full inflations delivered by stacking breaths from a volume-cycled ventilator or by insufflating air at adequate pressures using a mechanical insufflator-exsufflator. Second, normal levels of alveolar ventilation are sustained using a variety of noninvasive approaches, including nasal, oronasal, or mouthpiece interfaces. Third, patients must be taught to use techniques and devices to enhance cough, particularly the mechanical insufflator-exsufflator. When these goals are met, noninvasive NPPV can offer patients greater comfort, simpler and more convenient ventilator use, and reduced rates of infections, complications, and hospitalizations as compared with tracheostomy IPPV.
A retrospective analysis of 61 patients forms the basis for this paper's comment on three major types of pyogenic spinal disease. The first group consists of 22 patients with vertebral osteomyelitis and intervertebral discitis. The second group comprises 22 patients in whom the diagnosis of pyogenic spinal disease was made only after failure of discectomy. In retrospect they were shown to have atypical degenerative disc disease and were similar to the first group. The third group of 17 patients, while demonstrating some similarities to the second group, represents true postdiscectomy wound infection. An understanding of the clinical presentation and pathophysiology of pyogenic disease of the spine allows it to be distinguished preoperatively from degenerative disc disease which superficially it resembles. Further, true postdiscectomy wound infection can be distinguished from pyogenic spinal disease misdiagnosed preoperatively. The differences in the results of treatment of these three groups warrant such distinctions.
The potential relative beneficial aspects of upright, weight-bearing (pMRI), dynamic-kinetic (kMRI) spinal imaging over that of recumbent MRI (rMRI) include the revelation of occult spinal disease dependent on true axial loading, the unmasking of kinetic-dependent spinal disease and the ability to scan the patient in the position of clinically relevant signs and symptoms. This imaging unit under study also demonstrated low claustrophobic potential and yielded comparatively high resolution images with little motion/magnetic susceptibility/chemical shift artifact. Overall, it was found that rMRI underestimated the presence and maximum degree of gravity-dependent spinal pathology and missed altogether pathology of a dynamic nature, factors that are optimally revealed with p/kMRI. Furthermore, p/kMRI enabled optimal linkage of the patient's clinical syndrome with the medical imaging abnormality responsible for the clinical presentation, thereby allowing for the first time an improvement at once in both imaging sensitivity and specificity.
A study was made of the morphological and morphometrical features of muscle spindles in biopsies of patients with Werdnig-Hoffmann disease (infantile spinal muscular atrophy type I) to investigate the possible involvement of the muscle spindles in the pathological processes of the disease. A total of 57 muscle spindles from 26 cases were studied. The parameters determined were: the diameter and area of spindles, the number, diameter and area of intrafusal fibers, the number and area of nuclei. In addition, the ratio of the area of the intrafusal fibers to the area of nuclei and the ratio of the area of the spindle to the area of the intrafusal fibers were calculated. Statistical evaluation of the data showed significant differences regarding the area of the muscle spindle, the diameter of the intrafusal fibers and the mean area of nuclei of the intrafusal fibers, which were all smaller in patients than in controls (p=0.03, 0.01 and 0.02, respectively), while the thickness of the capsule was greater in patients than in controls (p=0.01). Our results indicate that the muscle spindle participates in the pathological processes of Werdnig-Hoffmann disease.
Somatosensory evoked potentials (SEP) were recorded at the scalp and at various levels along the lumbar and caudal thoracic parts of the spine in response to tibial nerve stimulations. The SEP were observed in 24 diseased dogs, 2 with a vertebral fracture, 1 with a spinal cord tumor, 1 with a vertebral tumor, and 20 with disk herniation. Cord compression location was confirmed by myelography, laminectomy, or both. The clinical state had significant (P < 0.0001) influence on SEP characteristics. The scalp-recorded SEP latency changed only in association with the most severe lesions; spine-recorded SEP conduction velocity was lower in association with mild lesions; scalp-recorded SEP amplitude changed with lesions of intermediary severity. Because these 3 electrophysiologic variables were influenced differently by cord damage, it was possible to discriminate the various clinical grades by use of these techniques. However, dogs with signs of pain only could not be differentiated from clinically normal dogs. The evoked injury potential was observed in all but 4 diseased dogs, and its maximal amplitude corresponded, in all cases, with cord damage location. Increased duration (P < 0.05) of the spine-recorded SEP was associated with long-standing problems, but not necessarily with clinically detectable malfunction. Use of SEP and evoked injury potential for identifying lateralized cord damage may be of value.
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We discuss the most important differential diagnosis in acute non traumatic spinal cord lesions. To therapy these patients, a large diagnostic and therapeutic spectrum must be considered. Nontraumatic spinal cord lesions include inflammatoric, immunologic, toxic-metabolic and physical reasons, tumours, bleedings, myelomalazies, neurodegenerative myelopathies and spinal deformities. The aimes of rehabilitation of these patients are almost similar to patients with tramatic spinal cord injured.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Twenty-six patients undergoing long-term hemodialysis who had hand and wrist abnormalities were examined for the presence of concurrent spinal disease. Six patients (23%) were found to have spinal disease on radiographs. In four, the findings resembled those of a destructive spondyloarthropathy, and in two, a less destructive erosive arthritis. A review of the spinal radiographs of 31 patients with normal hands and wrists revealed no such abnormalities. Postmortem examinations of two patients with spondyloarthropathy demonstrated extensive deposition of beta-2 microglobulin, an amyloid-like substance. The authors conclude that the disease is similar in both areas and represents a skeletal response to chronic renal failure and long-term hemodialysis. The disease may occur more frequently with an increased duration of hemodialysis, in one area of the skeleton if another area is already affected, and is probably not infectious if multiple areas are involved.
Skeletal collections are often useful for determining the frequency and distribution of lesions that would otherwise go unnoticed in the living. This study examines a rather common spinal lesion for which there is little clinical or paleopathologic literature available. In such cases, the anterior aspect of the lower thoracic and lumbar vertebral plates display crescent-shaped lesions suggestive of a form of degeneration known as intervertebral osteochondrosis. A total of 2,628 skeletons from three early American Indian sites and one 20th-century medical-school cadaver population are examined for this lesion. Variables such as age, sex, weight, race, activity patterns, and other biocultural information are considered in relation to the frequency of this lesion. It is suggested that physical stress during the second and third decades of life is largely responsible for this condition. With advancing age the lesions are obliterated and, in effect, become indistinguishable from spondylosis deformans. Familiarity with this condition is necessary in order to better understand degenerative spinal disease and avoid confusion with other spinal diseases such as tuberculosis.
The normal neural pathways involved in erection and ejaculation and the various spinal cord and central nervous system disorders that can adversely affect these functions are reviewed in this article. Also outlined are treatment strategies currently being employed.