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At least 613 records · Page 34Linked to original sources
PubMed2006

Can the results 6 months after anterior cervical decompression and fusion identify patients who will have remaining deficit at long-term?

PURPOSE: There is no knowledge if short-term outcome in patients after anterior cervical decompression and fusion (ACDF) can be used to identify which patients have remaining deficit in long term. This study investigates if 6-month outcome with a broad assessment after ACDF with a cervical intervertebral fusion cage can be a guide for the 3-years outcome. METHOD: A prospective study. Questions about background data, pain, numbness, neck specific disability, distress, sick leave, health, symptom satisfaction and effect of and satisfaction with surgery were asked 28 patients 3 years after ACDF. Measurements have earlier been obtained before and 6 and 12 months after ACDF. RESULTS: Compared with the results before surgery patients had improved in pain intensity (p = 0.001), neck pain (0.001), numbness (p = 0.02) and were more 'satisfied' with having their neck problems (p = 0.01). Except for a worsening in expectations of surgery fulfilled (p = 0.04) there were no significant differences between 6-month and 3-year outcome. Three years after ACDF about two-thirds of the patients had remaining deficit with regard to pain intensity, Neck Disability Index, Distress and Risk Assessment Method and general health. According to the parameters studied 50 - 78% of those who at the 6-month follow-up were without deficit were still healthy at the 3-year follow-up. For patients with deficit at 6-month follow-up, still 83 - 100% had deficit 3 years after surgery. CONCLUSIONS: Despite a rather small study obtained the stability of 6-month and 3-year results indicates that short-term results might be sufficient for evaluating effects of the treatment. Since the patients in this study clearly demonstrate broad problems array of development of more structured multi-professional rehabilitation models including exercises which improve neck muscle strength, endurance and proprioception need to be introduced.

Adult↗
PubMed2003

Depersonalization disorder: a functional neuroanatomical perspective.

Clinical reports of depersonalization suggest that attenuated emotional experience is a central feature of the condition. Patients typically complain of emotional numbness and some patients ascribe their feelings of unreality to a lack of affective "colouring" in things perceived. Recent neuroimaging and psychophysiological studies support these assumptions as they show both attenuated autonomic responses in depersonalization, and decreased activity within neural regions important for the generation of affective responses to emotive stimuli. Furthermore, findings from neuroimaging studies indicate increased prefrontal cortical activity in depersonalised patients, particularly within regions associated with contextualization and appraisal of emotionally-salient information rather than mood induction per se. Taken together, these finding suggest that symptoms of depersonalization, and in particular emotional numbing, may be related to a reversal of normal patterns of autonomic and neural response to emotive stimuli.

Affect↗
PubMedDate not supplied

The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma City bombing.

BACKGROUND: The course of posttraumatic stress disorder (PTSD) in populations directly exposed to terrorist attacks is of major importance in the post-9/11 era. Because no systematic diagnostic studies of the most highly exposed individuals of the 9/11 terrorist attacks have yet been done, the Oklahoma City bombing remains a unique opportunity to examine PTSD over time in high-exposure terrorist victims. METHODS: This study assessed 137 survivors in the direct path of the explosion at approximately 6 and 17 months postdisaster, using the Diagnostic Interview Schedule. RESULTS: Combined index and follow-up data yielded a higher (41%) incidence of PTSD than detected at index (32%) or follow-up (31%). All PTSD was chronic (89% unremitted at 17 months) with no delayed-onset cases. The avoidance and numbing symptom group C, unlike groups B and D alone, was pivotal to current PTSD status and was associated with indicators of functioning at index and follow-up. The findings at index were sustainable. CONCLUSIONS: This follow-up study confirmed the immediacy of onset of PTSD and its persistence over time, pointing to the need for early interventions that continue over the long term. Group C avoidance and numbing symptoms may aid in early recognition of PTSD and in predicting long-term functioning.

Adult↗
PubMed2004

Primary diffuse large cell lymphoma of the mandible.

Primary diffuse large cell lymphoma of the mandible is a rare form of extranodal non-Hodgkin's lymphoma (NHL). Herein we present 4 cases treated at our institution over a 5-year period and review 40 cases previously reported in the English-literature. The median age at presentation is 51 years with equal distribution between males and females. At presentation the lymphoma is usually limited to the jaw (stage IE) and the most common presenting symptoms include swelling of the jaw (58%), pain (53%), and mental dysesthesia or numbness (20%). Despite symptoms of numb chin syndrome, central nervous system (CNS) involvement at presentation has not been reported. The reported therapy of this rare diffuse large cell lymphoma presentation is very heterogeneous, however majority of patients were treated with combination of chemotherapy and radiotherapy with estimated 5-year overall survival of only 60%. Multi-center prospective clinical trials are needed to determine the optimal therapeutic approach to this rare diffuse large cell lymphoma presentation.

Adult↗
PubMed2003

Vitamin B12 deficiency in spinal cord injury: a retrospective study.

BACKGROUND/OBJECTIVE: Vitamin B12 (or cobalamin) deficiency is well known in geriatric patients, but not in those with spinal cord injury (SCI). This retrospective study describes vitamin B12 deficiency in SCI. METHODS: This study utilized a retrospective chart review of patients with SCI who had received serum vitamin B12 testing over the last 10 years. RESULTS: Probable vitamin B12 deficiency was noted in 16 patients with SCI. Twelve patients had subnormal serum vitamin B12 levels (< 220 pg/mL), whereas 4 patients had low-normal vitamin B12 levels (< 300 pg/mL) with neurologic and/or psychiatric symptoms that improved following vitamin B12 replacement. Classic findings of paresthesias and numbness often were not evident; such findings likely were masked by the pre-existing sensory impairment caused by SCI. Of the 16 SCI patients, 7 were ambulatory; 4 of the 7 presented with deterioration of gait. In addition, 3 of the 16 SCI patients presented with depression and fatigue, 2 had worsening pain, 2 had worsening upper limb weakness, and 2 had memory decline. Of the 12 patients with subnormal serum vitamin B12 levels, 6 were asymptomatic. Classic laboratory findings of low serum vitamin B12, macrocytic red blood cell indices, and megaloblastic anemia were not always present. Anemia was identified in 7 of the 16 patients and macrocytic red blood cells were found in 3 of the 16 patients. Only 1 of the 16 SCI patients had a clear pathophysiologic mechanism to explain the vitamin B12 deficiency (ie, partial gastrectomy); none of the patients were vegetarian. Twelve of the SCI patients appeared to experience clinical benefits from cyanocobalamin replacement (some patients experienced more than 1 benefit), including reversal of anemia (5 patients), improved gait (4 patients), improved mood (3 patients), improved memory (2 patients), reduced pain (2 patients), strength gain (1 patient), and reduced numbness (1 patient). CONCLUSION: It is recommended that physicians consider vitamin B12 deficiency in their patients with SCI, particularly in those with neurologic and/or psychiatric symptoms. These symptoms often are reversible if treatment is initiated early.

Adult↗
PubMed2026

Efficacy of targeted neuromodulation treatments: a clinical report.

BACKGROUND: Peripheral neuropathy is a debilitating condition characterized by chronic pain, numbness, tingling, burning, and tightness/swelling. Conventional therapies often focus on symptom management, and some patients experience chronic and refractory symptoms. RESEARCH DESIGN AND METHODS: This retrospective clinical analysis evaluated the clinical outcomes of neuromodulation neuropathy treatment using the NeuroGen-Series device in patients with diabetic peripheral neuropathy (DPN) or idiopathic peripheral neuropathy (IPN). 9,805 unique patients who underwent 133,741 treatments between 18 August 2017, and 23 July 2024, were analyzed. Patients were divided into treatment completers (&#x2265;24 sessions) and noncompleters (<24 sessions). Paired t-tests confirmed statistically significant reductions in pre- and post-treatment symptom scores (p&#x2009;<&#x2009;0.001). RESULTS: Among completers, symptom severity decreased by an average of 46.2%. Tingling and pain showed the greatest improvement, while tightness/swelling and numbness showed the least reduction. 64% of patients reported improvement after one session, and 84% reported improvement after 24 sessions. Nonresponders accounted for 5.8% of patients overall. Younger patients and those with higher initial symptom severity were more likely to discontinue treatment. CONCLUSIONS: Overall, neuromodulation treatment resulted in statistically significant reductions in symptom severity, though nonresponders and high attrition rate highlight the need for individualized treatment strategies and further investigation.

Humans↗
PubMed2006

Temperature limit values for touching cold surfaces with the fingertip.

OBJECTIVES: At the request of the European Commission and in the framework of the European Machinery Directive, research was performed in five different laboratories to develop specifications for surface temperature limit values for the short-term accidental touching of the fingertip with cold surfaces. METHODS: Data were collected in four laboratories with a total of 20 males and 20 females performing a grand total of 1655 exposures. Each touched polished blocks of aluminium, stainless steel, nylon-6 and wood using the distal phalanx of the index finger with a contact force of 1.0, 2.9 and 9.8 N, at surface temperatures from +2 to -40 degrees C for a maximum duration of 120 s. Conditions were selected in order to elicit varying rates of skin cooling upon contact. Contact temperature (TC) of the fingertip was measured over time using a T-type thermocouple. RESULTS: A database obtained from the experiments was collated and analysed to characterize fingertip contact cooling across a range of materials and surface temperatures. The database was subsequently used to develop a predictive model to describe the contact duration required for skin contact temperature to reach the physiological criteria of onset of pain (15 degrees C), onset of numbness (7 degrees C) and onset of frostbite risk (0 degrees C). CONCLUSIONS: The data reflect the strong link between the risk of skin damage and the thermal properties of the material touched. For aluminium and steel, skin temperatures of 0 degrees C occurs within 2-6 s at surface temperatures of -15 degrees C. For non-metallic surfaces, onset of numbness occurs within 15-65 s of contact at -35 degrees C and onset of cold pain occurs within 5 s of contact at -20 degrees C. The predictive model subsequently developed was a non-linear exponential expression also reflecting the effects of material thermal properties and initial temperature. This model provides information for the protection of workers against the risk of cold injury by establishing the temperature limits of cold touchable surfaces for a broad range of materials, and it is now proposed as guidance values in a new international standard.

Adolescent↗
PubMed2002

Identification of circadian-clock-regulated enhancers and genes of Drosophila melanogaster by transposon mobilization and luciferase reporting of cyclical gene expression.

A new way was developed to isolate rhythmically expressed genes in Drosophila by modifying the classic enhancer-trap method. We constructed a P element containing sequences that encode firefly luciferase as a reporter for oscillating gene expression in live flies. After generation of 1176 autosomal insertion lines, bioluminescence screening revealed rhythmic reporter-gene activity in 6% of these strains. Rhythmically fluctuating reporter levels were shown to be altered by clock mutations in genes that specify various circadian transcription factors or repressors. Intriguingly, rhythmic luminescence in certain lines was affected by only a subset of the pacemaker mutations. By isolating genes near 13 of the transposon insertions and determining their temporal mRNA expression pattern, we found that four of the loci adjacent to the trapped enhancers are rhythmically expressed. Therefore, this approach is suitable for identifying genetic loci regulated by the circadian clock. One transposon insert caused a mutation in the rhythmically expressed gene numb. This novel numb allele, as well as previously described ones, was shown to affect the fly's rhythm of locomotor activity. In addition to its known role in cell fate determination, this gene and the phosphotyrosine-binding protein it encodes are likely to function in the circadian system.

Animals↗
PubMed2005

Cryptorchidism in LhrKO animals and the effect of testosterone-replacement therapy.

BACKGROUND: The objective of the current study was to characterize the morphological and genetic basis of cryptorchidism. METHODS AND RESULTS: We investigated cryptorchidism in LH receptor (Lhr) knockout (LhrKO) mice and how testosterone-replacement therapy (TRT) worked to correct the phenotype. The results revealed that while gubernacular development was indistinguishable between Lhr-null and wild-type animals until 7 days of age, it was subsequently severely impaired in null animals. This was due to a reduction in mesenchymal cell division, differentiation into cremaster muscle cells and their delayed maturation. While transcript levels of Hoxa10, Hoxa11, Desrt and Dll1 were indistinguishable, the levels of Notch1, Numb and Lgr8 in the gubernaculum and Insl3 in the testes were lower in Lhr-null than in wild-type siblings. The TRT, which completed testicular descent into the scrotum, corrected the morphological changes and the expression of Lgr8, Numb and Notch, but not Insl3, to wild-type levels. Transection of the genitofemoral nerve did not prevent the TRT effect. CONCLUSION: In summary, cryptorchidism in Lhr-null animals was caused by defects in the gubernacular development due to testosterone deficiency. TRT reversed all the morphological and gene expression changes except Insl3, suggesting that testosterone, not INSL3, secreted by Leydig cells, facilitates the completion of testicular descent.

Animals↗
PubMed2005

A screening questionnaire for HAVS?

AIM: To define the diagnostic power of simple questions most applicable for a hand-arm vibration syndrome (HAVS) assessment screening questionnaire. METHOD: Using a binary logistic regression we analysed 365 physician led HAVS health surveillance assessments to identify which questions could form the basis of a screening questionnaire. RESULTS: Four sensorineural related questions regarding tingling and numbness in response to the cold and after using vibrating tools, and two vascular-related questions focusing on the patient's fingers going white on exposure to cold and numbness during an attack of whiteness were identified. CONCLUSIONS: Questions of high sensitivity for screening subjects for the vascular and neurosensory components of HAVS were identified, which can be used to identify those requiring further clinical investigation and functional testing.

Adult↗
PubMed1998

Transient neurologic syndrome in one thousand forty-five patients after 3% lidocaine spinal anesthesia.

UNLABELLED: Recent reports have discussed the potential risk of transient radicular irritation (TRI) after spinal anesthesia with lidocaine. Because we have not encountered such neurologic sequelae with the high incidence reported, we prospectively examined the incidence of TRI after spinal anesthesia with lidocaine. One thousand forty-five adult patients (aged 47 +/- 15 yr) receiving spinal anesthesia with 3% hyperbaric lidocaine (1.0-1.5 mL) for anorectal surgery were consecutively studied. After the induction of spinal anesthesia, all patients were placed in the prone position for surgery. Patients were evaluated for neurologic symptoms in the buttocks, thighs, or lower extremities using a checklist to standardize data collection. Although there was no complaint of neurologic symptoms on Postoperative Day (POD) 1, four patients (0.4%) reported aching, hypesthesia, numbness, or dull pain of both lower extremities and buttocks by the morning of POD 3. In three patients, the symptoms resolved without any treatment by POD 5, whereas in one patient, numbness of the lower extremities lasted until POD 7. We conclude that a combination of lidocaine with surgical position or leg manipulation during surgery might be a major contributing factor in the development of transient neurologic syndrome. IMPLICATIONS: Recent studies have reported the potential risk of transient neurologic syndrome after lidocaine spinal anesthesia. The current study reports a low incidence of such sequelae in 1045 patients undergoing anorectal surgery during the prone position. Other factors, such as surgical position, may be important in the development of this syndrome.

Adult↗
PubMed2005

Comparison of the different approaches to saphenous nerve block.

BACKGROUND: The authors compared the efficacy of the different approaches to saphenous nerve block. METHODS: The following approaches to saphenous nerve block were compared in 10 volunteers: perifemoral, transsartorial, block at the medial femoral condyle, below-the-knee field block, and blockade at the level of the medial malleolus. Each volunteer underwent all five blocks, and the interval between blocks was 3-7 days. The sequence of injection was randomized by Latin square design. Sensory blockade at the medial aspects of the leg and foot and the strength of the anterior thigh muscles were noted. RESULTS: The transsartorial, perifemoral, and below-the-knee field block approaches were more effective than block at the medial femoral condyle in providing sensory anesthesia to the medial aspect of the leg. The transsartorial approach was more effective than block at the medial femoral condyle and below-the-knee field block in providing sensory anesthesia to the medial aspect of the foot. Compared with the perifemoral approach, the transsartorial approach did not cause weakness of the hip flexors and the knee extensors. In volunteers with partial numbness in the medial aspect of the foot, supplemental block of the medial dorsal cutaneous branch of the superficial peroneal nerve resulted in complete sensory blockade. CONCLUSIONS: Sensory blockade in the medial aspects of the leg and foot is best achieved with the transsartorial approach. In some subjects, supplementary block of the medial dorsal cutaneous branch of the superficial peroneal nerve may have to be performed to assure complete numbness of the medial aspect of the foot.

Adult↗
PubMed1999

Subjective recovery of nerve graft donor site.

Nerve graft procedures require the use of a donor nerve to supply the graft material. This results in an area of numbness in a less critical region. The purpose of this study was to assess donor site recovery using patient subjective evaluation. Thirty-one patients (mean age, 38 years) who were at least 2 years past a nerve graft procedure participated in the telephone survey. The mean time since surgery was 65 months. Donor nerves from the lower extremity were utilized in 16 patients and from the upper extremity in 15 patients. The subjective patient evaluations indicated low levels of pain, numbness, and cold sensitivity in the donor nerve sensory distribution. Patient factors, including workers' compensation and legal involvement, did not have a significant effect on recovery at the donor site. Function and daily activity were not affected significantly by donor site factors. Satisfaction with nerve graft recovery was related significantly to reported patient satisfaction of the donor site (p = 0.002).

Adolescent↗
PubMedDate not supplied

Age differences in post-breast cancer lymphedema signs and symptoms.

This secondary data analysis was designed to explore the age differences in lymphedema (LE) occurrence and self-reported symptoms in post-breast cancer LE. A descriptive-exploratory cross-sectional design was used with a convenience sample composed of 102 women treated and followed for breast cancer at a midwestern cancer center. Sequential circumferential arm measurement was used to estimate limb volume differences. Self-reported symptoms were assessed by the Lymphedema and Breast Cancer Questionnaire (LBCQ) designed and tested by the research team. Lymphedema occurrence was relatively higher (41.2%) in breast cancer survivors younger than 60 than in those older than 60 (30.6%). Six subjectively reported symptoms were found to occur more often (P </= .05) in the younger women with LE: numbness now and in the past year, tenderness in the past year, aching now and in the past year, increased temperature in arm now. Numbness, tenderness, and aching were the most prevalent symptoms among women in both age groups regardless of LE presence. Our findings suggest that younger breast cancer survivors may have increased LE risk and report LE-related symptoms more often. Future research should focus on age differences in LE risk, occurrence, and perceptions of LE-related symptoms in women treated for breast cancer.

Adult↗
PubMed1996

Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy.

In this study, we reevaluate the results of radiofrequency rhizotomy and review the effectiveness of other surgical procedures for the treatment of trigeminal neuralgia. Five hundred patients with trigeminal neuralgia underwent radiofrequency rhizotomy at the University of Cincinnati Medical Center, Cincinnati, OH, between 1981 and 1986. Their results are compared with those of patients reported in the literature who underwent radiofrequency rhizotomy (6205 patients), glycerol rhizotomy (1217 patients), balloon compression (759 patients), microvascular decompression (MVD) (1417 patients), and partial trigeminal rhizotomy (250 patients). Comparisons were based on the following outcome parameters: technical success, pain relief and recurrence, facial numbness, dysesthesia, corneal anesthesia, keratitis, trigeminal motor dysfunction, permanent cranial nerve deficit, intracranial hemorrhage or infarction, perioperative morbidity, and perioperative mortality. We found that MVD had the lowest rate of technical success. Radiofrequency rhizotomy and MVD had the highest rates of initial pain relief and the lowest rates of pain recurrence. Glycerol rhizotomy had the highest rate of pain recurrence. Balloon compression had the highest rate of trigeminal motor dysfunction. Balloon compression and MVD had the lowest rates of corneal anesthesia or keratitis. MVD had the lowest rates of facial numbness and dysesthesia. All percutaneous procedures had similar rates of dysesthesia. Posterior fossa exploration had the highest rates of permanent cranial nerve deficit, intracranial hemorrhage or infarction, and perioperative morbidity and mortality. On the basis of our experience and a review of the literature, we conclude the following: 1) percutaneous techniques and posterior fossa exploration offer advantages and disadvantages, 2) radiofrequency rhizotomy is the procedure of choice for most patients undergoing first surgical treatments, and 3) MVD is recommended for healthy patients who have isolated pain in the first ophthalmic trigeminal division or in all three trigeminal divisions and patients who desire no sensory deficit.

Adult↗
PubMed1996

Analysis of the relationship between long-term operative success and a transient or delayed operative side effect.

OBJECTIVE: Investigators sometimes correlate the success of an operative procedure with the presence of an operative side effect that is thought to reflect the efficacy of the procedure in some way. When the prevalence of the side effect increases or decreases with time, this type of analysis can introduce a systematic bias. METHODS: Monte Carlo-simulated patient cohorts with independently and randomly generated operative success and presence of side effects were generated. Kaplan-Meier analyses of operative success were stratified by the presence of side effects at various times after the "operation." RESULTS: When the side effect (such as numbness after an ablative procedure) resolved during the study period in a significant proportion of patients, stratification by presence of the side effect at the end of the study period introduced a serious bias in favor of apparent better pain relief in patients without numbness. When the prevalence of the side effect increased with time (such as the requirement for a subsequent operation for radiation necrosis after brachytherapy or radiosurgical treatment of a glioma), the analysis was biased in favor of apparent longer survival for patients who experienced the side effect (i.e., those who required subsequent operations). CONCLUSION: Analyses of operative success stratified by the presence of postoperative side effects with time-varying prevalence may be seriously biased and should be interpreted with caution.

Bias↗
PubMed1996

Third cervical nerve root and ganglion compression: clinical syndrome, surgical anatomy, and pathological findings.

OBJECTIVE: The aim of this study is to determine whether C3 nerve root and ganglion compression occurs and, if so, to provide a preliminary description of the associated clinical syndrome and surgical pathological findings. METHODS: The normal anatomy of the C2-C3 foramen was studied bilaterally in five fresh cadaver dissections and on 10 normal vertebral angiograms. Six patients were selected whose C3 dermatome sensory deficits resolved after C2-C3 facetectomy for C3 nerve root and ganglion decompression. RESULTS: Patients with C3 nerve root and ganglion compression presented with radiating pain, dysesthesias, and numbness referred to the C3 pain dermatome: the scalp area behind and over the ear, the pinna, and the angle of the mandible. At physical examination, the presence of analgesia/dense hypalgesia in the C3 pain dermatome established the diagnosis. Imaging studies were suggestive but inconclusive. Surgical pathological findings showed the C3 nerve root and medial portion of the ganglion flattened by C2-C3 facet and uncovertebral joint spurs and the lateral part of the ganglion stretched and flattened by C2-C3 arthrosis and the C2-C3 vertebral loop. Decompression was obtained by a complete facetectomy. Complications required four operations: recurrence, contralateral C3 root decompression, bilateral C2 nerve root decompression, and C2-C3 fusion. CONCLUSION: C3 nerve root and ganglion compression, although uncommon, does occur. It presents with radiating pain, dysesthesias, numbness, and a C3 dermatome sensory deficit. The associated clinical syndrome resolves after facetectomy and C3 root and ganglion decompression.

Adult↗
PubMed1998

Intraosseous schwannoma of the fourth lumbar vertebra: case report.

OBJECTIVE AND IMPORTANCE: Intraosseous schwannomas (neurilemomas) are rare neoplasms. In one large series, schwannomas accounted for less than 0.2% of all primary bone tumors. These schwannomas most commonly arise in the mandible and have also been observed, very rarely, in the vertebra. We present a patient with an unusual intraosseous schwannoma in the lumbar vertebra. CLINICAL PRESENTATION: A 58-year-old man who was admitted to Cathay General Hospital had complained of numbness and pain in his lower extremities for approximately 1 year. At the time of admission, a neurological examination revealed mild motor weakness and sensory numbness bilaterally in his lower legs. Magnetic resonance images showed a neoplastic lesion occupying the entire L4 body and the superior part of the L5 body, with marked perivertebral protrusion and compression of the thecal sac and bilateral neuroforamina. INTERVENTION: The patient underwent a computed tomography-guided needle biopsy and a two-stage operation. During the initial surgical procedure, the tumor mass was totally removed via an anterolateral approach. Fixation and fusion of the third to fifth lumbar vertebral bodies was accomplished using a full-thickness iliac bone graft with an anterior locking plate and screws. During the second operation, posterior fusion of L2, L3, L4, L5, and S1 with Luque wires and a Hartshill rectangle rod was performed to increase the spinal stability. CONCLUSION: Intraosseous schwannomas are rare neoplasms that are not commonly observed in the lumbar vertebral bodies. Schwannomas in the lumbar spine commonly originate from the nerve passing through the neural foramina. We report a rare case of L4 intraosseous schwannoma, the magnetic resonance imaging, computed tomographic, and histological findings, and the surgical procedures.

Biopsy, Needle↗