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PubMed2006

Lower extremity nerve function in patients with lower extremity ischemia.

BACKGROUND: We determined whether lower extremity ischemia, as measured by the ankle brachial index (ABI), is associated with impaired lower extremity nerve function. METHODS: Participants included 478 persons with peripheral arterial disease (PAD) identified from noninvasive vascular laboratories and 292 persons without PAD identified from a general medicine practice and noninvasive vascular laboratories. Peripheral arterial disease was defined as an ABI lower than 0.90 (mild PAD: ABI, 0.70 to <0.90; moderate PAD: ABI, 0.50 to <0.70; and severe PAD: ABI, <0.50). The ABI and electrophysiologic measures of the peroneal, sural, and ulnar nerves were obtained. RESULTS: Among 546 participants without diabetes, PAD participants had significantly impaired peripheral nerve function in the upper and lower extremities compared with non-PAD participants. After adjusting for age, sex, race, smoking, height, body mass index, recruitment source, alcohol use, disk disease, spinal stenosis, cardiac disease, and cerebrovascular disease, these associations were not statistically significant. After adjusting for confounders among nondiabetic participants, those with severe PAD (ABI, <0.50) had poorer peroneal nerve conduction velocity (NCV) compared with participants without PAD (42.6 vs 44.8 m/s; P = .003) and poorer peroneal NCV compared with participants with mild PAD (42.6 vs 45.0 m/s; P = .001) or moderate PAD (42.6 vs 44.1 m/s; P = .03). Among 224 participants with diabetes, after adjusting for confounders, PAD was associated with poorer peroneal NCV (40.8 vs 43.5 m/s; P = .01), sural nerve amplitude (3.1 vs 4.8 muV; P = .045), and ulnar NCV (47.6 vs 50.2 m/s; P = .03) compared with those without PAD. CONCLUSIONS: Our findings suggest that leg ischemia impairs peroneal nerve function. This association is less strong in patients with diabetes, perhaps because of the overriding influence of diabetes on peripheral nerve function. Clinicians should consider screening for PAD in patients with idiopathic peroneal nerve dysfunction. Peripheral arterial disease-associated nerve dysfunction may contribute to PAD-associated functional impairment.

Aged↗
PubMed2003

Mortality of purebred and mixed-breed dogs in Denmark.

Causes of death and age at death of 2928 dogs are reported from a questionnaire study among members of the Danish Kennel Club (DKC) in 1997. The dogs represented 20 breeds, 15 breed-groups and a group of mixed-breed dogs. The median age at death for all dogs in the study was 10.0 years. Mixed-breed dogs had a higher median age at death (11.0 years) than the entire population, but breeds like Shetland Sheepdog, Poodle and Dachshund exceeded this age (12 years). The Bernese Mountaindog, the group of Molossian types and the Sighthounds had the shortest life span with a median age at death of 7.0 years. Old age was the most frequent reported cause of death (20.8%) followed by cancer (14.5%), behavioural problems (6.4%) accidents (6.1%), hip dysplasia (4.6%), heart diseases (4.6%) and spinal diseases (3.9%). Breed-specific proportional mortalities with 95% confidence limits are given for the six most prevalent specific causes of death.

Aging↗
PubMed1997

Pediatric leptomeningeal metastases: outcome following combined therapy.

Fifteen children ranging in age from 4 to 18 years with leptomeningeal metastases were evaluated for extent of tumor and treated with radiotherapy or chemotherapy. Histologic diagnosis included: acute lymphoblastic leukemia (4); anaplastic astrocytoma (1); ependymoma (2); nonseminomatous germ cell tumor (1); non-Hodgkin's lymphoma (1); pineoblastoma (1); and primitive neuroectodermal tumor not otherwise specified (2). Pretreatment imaging studies demonstrated recurrent intracranial parenchymal disease in nine, spinal disease in four, and abnormal radioisotope ventriculography in six. Systemic disease was seen in four children (3 leukemia; 1 non-Hodgkin's lymphoma). All children were treated with systemic chemotherapy and intraventricular chemotherapy. Nine children received radiotherapy to bulky or symptomatic leptomeningeal disease. Median survival was 6 months (range, 4-18 months). Children with hematologic malignancies had superior outcomes compared to children with solid tumors. Three children with leukemic or lymphomatous meningitis are alive and disease free whereas all children with carcinomatous meningitis died. In conclusion, leptomeningeal metastases in children portends a limited survival, and therapies at this time remain palliative except in children with hematologic malignancies.

Adolescent↗
PubMed1998

[Radiologic diagnosis of osteoarticular tuberculosis and borderline skeletal diseases].

A total of 3305 ill children and adults treated for skeletal diseases and lesions underwent primary and follow-up radiation studies. Patients with spinal diseases amounted to 72%, of them 58% were found to have neurological diseases, 28% had articular diseases. The examination of patients involved X-ray tomography, contrast myelotomography, computed tomography, and magnetic resonance imaging. Surgical and laboratory verifications of the diagnosis were made in 53% of adults and 78.5% of children. It is shown that there are difficulties in diagnosing and differentiating osteoarticular tuberculosis at present and X-ray tomography and contrast myelography are essential in diagnosing spinal diseases. Indications for computed tomography and magnetic resonance imaging, osteoscintigraphy and the sequence of their use in the diagnosis of diseases were defined. The paper emphasizes that an osteoarticulogist's assessment of complex data of radiation diagnosis is very important.

Adolescent↗
PubMed1988

Spectrum of operations on the cervical spine in a neurosurgical spinal centre with trauma profile.

A statistical review is given about the treatment in the Neurosurgical Department of our Institute of cervical spine injuries and non-traumatic spinal diseases during 11 years, as well as about the trends of development in spine surgery. The ratio of operative and conservative methods is described, analysing the indications and yearly numbers of different surgical procedures as compared to the data of non-traumatic spinal diseases. Altogether 786 patients were treated, 319 operations were performed on the cervical vertebral column. By the follow-up of different surgical techniques a radical change of attitude has been shown: ventral desis has got the leading role instead of dorsal spondylodesis which formerly used to be the method of choice. In addition, combined dorsal and ventral desis, lateral exposure, screw-fixation of the dens axis and the Halo-method are important techniques of the up-to-date treatment in special types of injuries.

Cervical Vertebrae↗
PubMed1999

Hippocrates. The father of spine surgery.

Hippocrates (5th-4th century B. C.), the founder of scientific medicine, left a valuable heritage of knowledge and methodology, which extends to almost all branches of modern medicine. Among the many fields of medicine he explored, he devoted much of his scientific interest to the study of orthopedics. In fact, some of the principles found in the Hippocratic treatises On Fractures and On Joints are still valid today. This great physician also was the first to deal with the anatomy and the pathology of human spine. In his books, he provides a precise description of the segments and the normal curves of the spine, the structure of the vertebrae, the tendons attached to them, the blood supply to the spine, and even its anatomic relations to adjacent vessels. The Hippocratic list of spinal diseases includes tuberculous spondylitis, post-traumatic kyphosis, scoliosis, concussion, dislocations of the vertebrae, and fractures of the spinous processes. Hippocrates devised two apparatuses, known as the Hippocratic ladder and the Hippocratic board, to reduce displaced vertebrae. Those pioneer methods are deemed to be the precursors to the sophisticated techniques used in spine surgery today. Because of his thorough study of spinal diseases and their management, which was the first such study in orthopedics in the history of medicine, Hippocrates should be regarded as the father of spine surgery.

Greece, Ancient↗
PubMed1981

Somatosensory cerebral evoked potentials in spinal cord diseases.

Cortical-evoked potentials (CEPs) induced by the stimulation of the tibial nerve, were investigated in 16 patients with localized myelopathy, and in five patients with generalised myelopathy, and compared with the results obtained in 30 healthy test subjects. The investigations show that the pulses that give rise to the CEP, are conducted mainly by the posterior columns. Damage to the ventrolateral tracts, in contrast, leads only to a reduction in the amplitude of the CEPs. If account is taken of possible artefacts and misinterpretations, the method described is highly suitable for determining the level of a lesion in complete paraplegia and for obtaining information as to the size and extent of spinal cord damage in myelopathies.

Adolescent↗
PubMed1998

Ultrafine flexible spinal endoscope (myeloscope) and discovery of an unreported subarachnoid lesion.

STUDY DESIGN: Introduction of a new diagnostic procedure and a report on its usefulness. OBJECTIVES: To introduce a new endoscope (myeloscope) developed for the examination of the spinal canal and to present a previously unreported subarachnoid condition as a cause of paraparesis revealed by it. SUMMARY OF BACKGROUND DATA: In spite of the availability of advanced imaging technology, there still exists a significant number of patients with spinal diseases in whom a diagnosis cannot be made. Direct visualization of the pathologic area is required in these patients. Recent advances in fiberoptics have made this possible. METHODS: The endoscope consisted of a fiberscope with an external diameter of 0.5, 0.9, or 1.4 mm. It was inserted into the subarachnoid space in the lumbar spine and carefully advanced cranially. Since 1987, this examination has been performed on 18 patients aged 7 to 69 years who had pain or other neurologic symptoms of unknown origin. RESULTS: The surface of the spinal cord, roots, properties of the arachnoid membrane, and small vessels could be observed clearly. The scope could be advanced as far as the upper cervical spine. Cotton-candy-like proliferation of fibrous tissue was identified by myeloscopy in four paraparetic patients who had clinical and radiologic features similar to those of a spinal cord herniation. The fibrous tissue beat on the spinal cord with the pulsation of the spinal fluid. Resection of the fibrous tissue with conventional surgery resulted in neurologic improvement. Complications included one case of meningitis in the early period and five cases of postspinal headache. No nerve injury was apparent. CONCLUSIONS: Myeloscopy provides detailed information about the subarachnoid space and even reveals dynamic conditions that cannot be identified during open surgery or at autopsy. It will bring new concepts to the diagnosis of spinal diseases.

Adolescent↗
PubMedDate not supplied

Caring for patients with a diagnosis of cancer and spinal metastatic disease.

This article aims to provide a greater understanding of the process involved in diagnosing cancer, particularly that associated with spinal metastasis. The article focuses on the diagnosis of secondary cancer of the spine, however, the information and discussion might also be relevant to other anatomical areas.

Diagnostic Imaging↗
PubMed1998

The effects of capsaicin on the neurogenic hyperreflexic detrusor. A double blind placebo controlled study in patients with spinal cord disease. Preliminary results.

PURPOSE: Several recent open studies have provided encouraging results as to the efficacy of intravesical installations of capsaicin for neurogenic hyperreflectivity. The present trial was performed to verify these results under controlled conditions. Intravesical installation of capsaicin represents a new therapeutic hope for the treatment of the neurogenic hyperrelfexic bladder. METHOD: This randomized, double-blind study compared the results of the intravesical installation of 30 mg capsaicin in 100 ml of 30% alcohol (experimental group) with those of installing 100 ml 30% alcohol alone (control group). On day 0 and day 30, urodynamic and biopsic examinations were performed in all subjects of each group. PATIENTS: All the subjects included in the study had a functionally disabling form of neurogenic hyperreflexic bladder resistant to the usual therapies. Cystoscopy and retrograde cystography were performed to exclude any patient who presented with a tumor-like lesion or had vesicoureteral reflux. RESULTS: Twelve paraplegic of tetraplegic subjects, seven women and five men whose average age was 46, were included. Eight had multiple sclerosis, and four had sustained a traumatic spinal cord injury. The patients were randomly separated into two groups of six. Initially, there was no clinical or urodynamic differences in these groups. Installation immediately triggered side effects and during the first 7 days (suprapubic burning sensation, sensory urgency, hot flushes, autonomic hyperreflexia, hematuria) in five of the six subjects in both groups. Bladder biopsy revealed no significant deterioration. On day 30, there was improvement in all of the experimental-group of patients with significant regression of leakage (P = 0.002) and of sensory urgency (P = 0.01). Only one control subject had amelioration. Urodynamic examination showed a rise in bladder capacity from 172.5 to 312.3 ml in the experimental group, significantly greater (P = 0.03) than the rise from 129 to 175.3 ml observed in the control group. CONCLUSION: This trial fully confirms the efficacy of intravesical installations of capsaicin, an efficacy obtained at the cost of nonnegligible side effects. An intermediate-term follow-up of this treatment will be necessary before considering more widespread use of this agent.

Adult↗
PubMedDate not supplied

[Effect of apisatron in lumbar spinal cord diseases].

A therapeutic effect has been studied of the drug apizartron of the ESPARMA GmbH firm (Osterweddingen, Germany) in those patients presenting with damaged lumbar spine. The ointment apizartron has been shown to alleviate the pain syndrome and myotonic (spastic) reactions, with its effect having been somewhat less pronounced on radicular compression, neurodystrophic disorders, and on the arterial bloodflow of the inferior limbs. The drug is recommended for use in a complex therapy of vertebrogenic disorders of the lumbar spine.

Administration, Topical↗