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PubMed2001

The Iowa follow-up of chemically sensitive persons.

Clinical symptoms and self-reported health status in persons reporting multiple chemical sensitivities (MCS) are presented from a 9-year follow-up study. Eighteen (69%) subjects from a sample of 26 persons originally interviewed in 1988 were followed up in 1997 and given structured interviews and self-report questionnaires. In terms of psychiatric diagnosis, 15 (83%) met DSM-IV criteria for a lifetime mood disorder, 10 (56%) for a lifetime anxiety disorder, and 10 (56%) for a lifetime somatoform disorder. Seven (39%) of subjects met criteria for a personality disorder using the Personality Diagnostic Questionnaire-IV. Self-report data from the Illness Behavior Questionnaire and Symptom Checklist-90-Revised show little change from 1988. The 10 most frequent complaints attributed to MCS were headache, memory loss, forgetfulness, sore throat, joint aches, trouble thinking, shortness of breath, back pain, muscle aches, and nausea. Global assessment showed that 2 (11%) had "remitted", 8 (45%) were "much" or "very much" improved, 6 (33%) were "improved", and 2 (11%) were "unchanged/worse". Mean scores on the SF-36 health survey showed that, compared to U.S. population means, subjects reported worse physical functioning, more bodily pain, worse general health, worse social functioning, and more emotional-role impairment; self-reported mental health was better than the U.S. population mean. All subjects maintained a belief that they had MCS; 16 (89%) acknowledged that the diagnosis was controversial. It is concluded that the subjects remain strongly committed to their diagnosis of MCS. Most have improved since their original interview, but many remain symptomatic and continue to report ongoing lifestyle changes.

Aged↗

PubMed1995

The clinical differentiation of nervous and muscular locomotor disorders of sheep in Australia.

Many of the nervous and muscular locomotor disorders that affect sheep throughout Australia are commonly referred to as "staggers" syndromes. The range of clinical signs displayed by sheep suffering these disorders is sufficiently diverse to enable each syndrome to be graded into one of 5 progressive clinical groups. The first group, the limb paresis syndromes, includes the primary myopathies associated with the ingestion of Ixiolaena brevicompta, Malva parviflora, and Trachymene ochracea, as well as selenium and Vitamin E disorders, Paroo virus staggers, congenital progressive muscular dystrophy, humpy back, hypocalcaemic muscle weakness, Tribulus terrestris staggers and tetanus. The second group is characterised by limb paresis with knuckling of the fetlocks, and includes the plant-associated toxicities of Romulea rosea, Stachys arvensis, Trachyandra divaricata, and Tribulus micrococcus, together with haloxon toxicity, enzootic ataxia (copper deficiency), and the probably genetic disorders of segmental axonopathy, neuroaxonal dystrophy, and degenerative thoracic myelopathy. Other locomotor disorders that fit more loosely into this group are listerial myelitis (post-dipping staggers), vitamin A deficiency, cervico-thoracic vertebral subluxation Stypandra glauca toxicity, Ipomoea spp toxicity, ivermectin toxicity, and botulism. The third group, the falling syndromes, includes the probably genetic disorders of thalamic cerebellar neuropathy, cerebellar abiotrophy, and globoid cell leucodystrophy, together with Swainsona spp toxicity. The fourth group, the falling syndromes, includes the plant associated toxicities of phalaris staggers, perennial rye grass staggers and nervous ergotism (Claviceps paspali).(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗

PubMed1987

Interaction between the vestibulo-collic reflex and the cervico-collic stretch reflex in the decerebrate cat.

1. Interactions between the sagittal vestibulo-collic reflex (v.c.r.) and the cervico-collic stretch reflex (c.c.r.) have been studied in the neck extensor muscles biventer cervicis (b.c.) in the decerebrate cat. The v.c.r. was evoked by a 'standard' vestibular stimulus consisting of a sinusoidal nose-up, nose-down head movement of 6-8 deg amplitude at 1 Hz. The c.c.r. was evoked by sinusoidal stretching of the b.c. muscles at 1 Hz. The amplitude of muscle stretching, and its phase in relation to head movement, were systematically varied. 2. When muscle stretching was applied in phase with head movement (so that the muscles were stretched as the head moved in the nose-down direction), the gain of the combined (v.c.r. + c.c.r.) reflex in the b.c. muscles increased above that of the v.c.r. If the muscle stretching was applied out of phase with head movement (so that the muscles shortened as the head moved downward), the gain of the combined reflex was reduced to a value below that of the v.c.r. 3. The effects on the gain of the combined reflex varied in proportion to the amplitude of muscle stretching. The gain and phase of the combined reflex is modelled reasonably well by a linear vectorial addition between the v.c.r. and the c.c.r. over a wide range of amplitudes of muscle stretching. The linear summation model contains a proportionality constant K, which may represent a factor by which the two reflexes are 'calibrated' against each other. 4. If one of the b.c. muscles was held at a fixed length and the other stretched sinusoidally, the c.c.r. was evoked only in the stimulated muscle. Vestibular stimulation then summed with the c.c.r in the stimulated muscle, while on the contralateral side the reflex response was the same as that of the v.c.r. alone. It would appear therefore that the motoneurone pools of the b.c. muscles are organized as independent entities without mutually excitatory or inhibitory reflex linkages. This arrangement presumably allows flexibility in the supraspinal control of the b.c. muscles, which are often used either as synergists during sagittal head movement or as antagonists during horizontal or roll movements of the head. 5. The interaction between the v.c.r. and the c.c.r. results in an apparent 'servo-assistance' role for the muscle afferent feed-back from the b.c. muscles, amplifying or attenuating the reflex response of the muscles to a given head movement.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed2001

Adverse effects of oral corticosteroids in relation to dose in patients with lung disease.

BACKGROUND: The adverse effects of oral corticosteroids are widely recognised but there are few quantitative data on which to base advice to patients. In a two part cross sectional study we compared adverse effects in patients with lung disease taking oral corticosteroids and control subjects and related the adverse effects to corticosteroid dose in the patient group. METHODS: Data on oral corticosteroid use, lifestyle, fractures, and other possible adverse effects were collected by questionnaire and compared between a community based cohort of patients taking continuous or frequent intermittent oral corticosteroids for asthma, chronic obstructive pulmonary disease, or alveolitis and age and sex matched control subjects. Dose related effects were explored in the corticosteroid group using cumulative dose quartiles and multiple logistic regression. RESULTS: A total of 367 patients (> or = 50 years, 48% female) and 734 control subjects completed the questionnaire. The cumulative incidence of fractures since the time of diagnosis was 23% for patients taking oral corticosteroids and 15% in the control group (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.3 to 2.6). Patients were more likely to have had a fracture of the vertebrae (OR 10; 95% CI 2.9 to 34), hip (OR 6; 95% CI 1.2 to 30), and ribs or sternum (OR 3.2, 95% CI 1.6 to 6.6) than control subjects. They also reported a significant increase in cataracts, use of antacids, muscle weakness, back pain, bruising, oral candidiasis, and having fewer teeth. The effects of oral corticosteroids were dose related: the odds ratio for patients in the highest compared with the lowest cumulative dose quartile (median prednisolone dose 61 g versus 5 g) ranged from 2 for all fractures to 9 for vertebral fractures and bruising. CONCLUSIONS: By quantifying the morbidity associated with the use of oral corticosteroids, this study should help to rationalise their long term use.

Administration, Oral↗

PubMed1993

Dynamics of reflex cocontraction in hermit crab abdomen: experiments and a systems model.

1. Both stretch and release of the ventral superficial muscles (VSM) in the abdomen of the hermit crab, Pagurus pollicarus, activate the VSM motoneurons in the intact animal and in the isolated abdomen. 2. This reflex was studied by recording intracellularly from muscle fibers innervated by single motoneurons during stretch and release of the VSM. The three motoneurons of the right fourth segment respond to both stretch and release with a phasic burst lasting approximately 250 ms. The burst in the two tonic motoneurons has two components, a short burst lasting 10-20 ms, with a latency from the beginning of stretch of 60-90 ms, and a longer burst of variable length, with a latency of 120 ms. Ramp stretches of different amplitudes and velocities were used to show that the first component is proportional to the absolute value of the second derivative of force and the second component to the absolute value of the first derivative of force. 3. Stretch and release of the VSM also simultaneously evoke phasic bursts in the motoneurons of the dorsal superficial muscles and the VSM circular muscles (functional antagonists of the longitudinal VSM), as well as in contralateral homologues of the same segment and in ipsilateral homologues of the next anterior segment. The effect of this coactivation is to stiffen the abdomen in response to perturbations in any direction. 4. Stretch or release of phasic mechanoreceptors in the VSM evokes this reflex. Isometric electrical stimulation of the isolated muscle also activates them, showing that they are transducing changes in force and suggesting that they operate to increase muscle stiffness by positive feedback. 5. A mathematical systems model of this reflex, composed of two parallel pathways activating the motoneurons, was constructed. The first pathway produces a signal proportional to the absolute value of the second derivative of force, the second pathway a signal proportional to the first derivative of force. The sum of the signals from the two pathways is filtered by an adaptation process, which is followed by a low-pass filter representing muscle activation kinetics. The muscle activation signal is then fed back to multiple muscle force. 6. Simulations using this model generate the phasic bursts to stretch and release as well as reproducing the frequency dependence of this reflex. The predominant action of this reflex is to enhance muscle stiffness.

Abdomen↗

PubMed2001

Diagnosis of a patient with oncogenic osteomalacia using a phosphate uptake bioassay of serum and magnetic resonance imaging.

A previously healthy man with no family history of fractures presented with muscle pain, back pain and height loss. Investigations revealed hypophosphataemia, phosphaturia, undetectable serum 1,25-dihydroxyvitamin D and severe osteomalacia on bone biopsy, suggestive of a diagnosis of oncogenic osteomalacia. Thorough physical examination did not locate a tumour. Support for the diagnosis was obtained by detection of phosphate uptake inhibitory activity in a blinded sample of the patient's serum using a renal cell bioassay. On the basis of detection of this bioactivity, a total body magnetic resonance (MR) examination was performed. A small tumour was located in the right leg. Removal of the tumour resulted in the rapid reversal of symptoms and the abnormal biochemistry typical of oncogenic osteomalacia. Inhibitory activity was also demonstrated using the bioassay in serum from two other patients with confirmed or presumptive oncogenic osteomalacia, but not in serum from two patients with hypophosphataemia of other origin. This is the first case to be reported in which the diagnosis of oncogenic osteomalacia was assisted by demonstration of inhibitory activity of the patient's serum in a renal cell phosphate bioassay that provided an impetus for total body MR imaging.

Adult↗

PubMed2006

[Parathyroid carcinoma].

BACKGROUND: Parathyroid carcinoma is the least frequent malignancy among endocrine tumors. In the most reported series of patients with primary hyperparathyroidism the incidence of carcinoma is less than 1%. Racognition by a surgeon that the parathyroid tumor is malignant, and the performance of an adequate en bloc removal of primary lesion, with histologic diagnosis offer the best treatment of a patient with this unusual malignancy. CASE REPORT: We reported a 30-year-old patient with parathyroid carcinoma, primary hyperparathyroidism, and recurrent nephrocalcinosis. Marked hypercalcemia, low serum phosphorus, and substantial elevation of serum parathyroid hormone indicated a diagnosis of primary hiperparathyroidism. General symptoms were anorexia, muscle weakness, back pain and depression. Ultrasonography done before the surgery revealed a 2 cm upper left parathyroid gland with solid and cystic areas. The neck exploration was done with en block resection of the tumor. A histopathological evaluation confirmed the diagnosis of parathyroid carcinoma. Over more than a three-year-follow-up, the patient had no evidence of the disease recurrence and his serum PTH and calcium levels remained within the normal. CONCLUSION: Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. Preoperative diagnosis remains a challenge. Radical en bloc resection of the tumor is the treatment of choice for this malignancy.

Adult↗

PubMed2004

A review of anatomical and mechanical factors affecting vertebral body integrity.

Background: The aetiology of osteoporotic vertebral fracture is multifactorial and may be conceptualised using a systems framework. Previous studies have established several correlates of vertebral fracture including reduced vertebral cross-sectional area, weakness in back extensor muscles, reduced bone mineral density, increasing age, worsening kyphosis and recent vertebral fracture. Alterations in these physical characteristics may influence biomechanical loads and neuromuscular control of the trunk and contribute to changes in subregional bone mineral density of the vertebral bodies. Methods: This review discusses factors that have received less attention in the literature, which may contribute to the development of vertebral fracture. A literature review was conducted using electronic databases including Medline, Cinahl and ISI Web of Science to examine the potential contribution of trabecular architecture, subregional bone mineral density, vertebral geometry, muscle force, muscle strength, neuromuscular control and intervertebral disc integrity to the aetiology of osteoporotic vertebral fracture. Interpretation: A better understanding of factors such as biomechanical loading and neuromuscular control of the trunk may help to explain the high incidence of subsequent vertebral fracture after sustaining an initial vertebral fracture. Consideration of these issues may be important in the development of prevention and management strategies.

Journal Article↗

PubMed2001

[Neurosurgical aspects in achondroplasia: evaluation and treatment].

Achondroplasia is the most common genetic disorder associated with bone dysplasia. The mode of inheritance is autosomal dominance, while most cases appear to represent a new mutation. Achondroplastic patients suffer from dwarfism, and from typical features of the head and limbs (rhizomelia, macrocephaly, frontal bossing and kyphosis). Half of the patients show various neurological complications. The most serious complication of achondroplasia is respiratory impairment, apnea and sudden infant death, resulting from compression of the medulla oblongata. This study describes the neurosurgical sequels in 10 achondroplastic patients, who underwent 12 surgical procedures. The average age was 14 years (ages ranged from 3 months to 40 years). The patients suffered from back pain, muscle weakness, incontinence, hypotonia, psychomotor delay, apnea and respiratory arrest. Four patients were diagnosed as suffering from obstructive sleep apnea. Craniocervical MRI showed: narrowing of the foramen magnum, fusion of C1, spinal stenosis, and severe cervicomedullary or spinal cord compression. In 5 patients the MRI also showed ventriculomegaly of the lateral and third ventricles. Seven patients underwent foramen magnum decompression and C1 laminectomy. Three patients with severe spinal cord compression underwent laminectomy of the involved spines (T12-L5). Two of the patients required more then one operation due to the recurrence of their neurological symptoms. There was no need for duraplasty or shunt procedures. The average hospital stay was 6 days. Eight patients showed improvement or resolution of symptoms, with an average follow-up period of 13.5 months after the last operation (ranged 6-24 months). We conclude that early neurological and MRI evaluations are required in achondroplasia patients, in order to prevent the high morbidity and mortality during infancy and childhood. In adults, MRI evaluation is needed if the patient has neurological symptoms. Early identification and immediate cervicomedulary decompression procedure can prevent the serious complications occurring in achondroplasia, including respiratory failure, apnea and sudden death.

Achondroplasia↗

PubMed2003

[The transplantation of latissimus dorsi flap of the base of T shape artery with the pedicle of the thoracodorsal artery].

OBJECTIVE: To explore the possibility that the free latissimus dorsi musculo-cutaneous flap to repair the forearm leg wound. METHODS: To design latissimus dorsi musculo-cutaneous flap which is foundation on T form thoracodorsal artery stalk. To set the short arm into the receiver artery break and anastomos them. It is not only reassure the blood of free musculo-cutaneous flap, but also reconstruct the continuation of the receiver main artery. RESULTS: In 16 patients, 15 patients success completely, 1 patient main success. The blood supply of receiver is adequate. CONCLUSIONS: The free T form thoracodorsal artery stalk musculo-cutaneous flap free grafting is a good method to repair the skin and soft tissues defection of forearm and leg.

Anastomosis, Surgical↗

PubMed1952