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PubMed2006

Regional versus general anaesthesia for carotid endarterectomy: impact of change in practice.

BACKGROUND: Local anaesthesia (LA) for carotid endarterectomy (CEA) may offer advantages over general anaesthesia (GA). AIM: Our aim was to compare outcome from CEA before and after changing our anaesthetic technique from GA to LA. METHODS: Sequential patients who underwent CEA between January 1997 and December 2001 were identified from a prospectively collected database. GA was used during the first two years of this period and LA was used exclusively over the last three years. Differences in the incidence of intraoperative shunting, perioperative stroke and transient ischaemic attack (TIA), cranial nerve injury, neck haematoma, perioperative death and duration of hospital stay were assessed. RESULTS: Three hundred and seventy one CEAs were carried out in 363 patients, 179 under GA and 192 under LA. Indications were TIAs (140), stroke with recovery (134), amaurosis fugax (85) and asymptomatic high-grade stenosis (12). Intraoperative shunting was used in 66 (37%) GA operations and 36 (18.8%) LA operations (p<0.01). There were nine strokes and four transient neurological events; 10 (5.5%) patients developed such problems with GA and three (1.6%) with LA (p<0.05). There were four deaths, three (1.7%) after GA and one (0.5%) after LA (p=NS). Duration of hospital stay was less in the LA group at a median (range) of three days (2-10) compared with 4.5 (3-14) days in the GA group (p<0.001). CONCLUSION: Employing LA rather than GA for CEA has been associated with a reduction in intraoperative shunting and perioperative stroke, and the duration of hospital stay. LA appears to offer clinical and possible cost advantages over GA.

Adult↗
PubMed2005

Immunohistochemistry as a method to study elastic fibers of human vocal fold.

AIM: Verify the use of immunohistochemistry as a method to measure all forms of elastic fibers at human vocal folds. STUDY DESIGN: Transversal cohort. MATERIAL AND METHOD: We collected vocal folds following these criterion: age between 25 and 40, Caucasian men, dead by gun shot, within 12 hours of death, without instrumentation of the larynx or suspicion of neck injury and without mucosal lesions noted by microscopy. Ten vocal folds were collected and one, of a man aged 28 years, was selected to study. The vocal fold was transversely cut in 9 regions and in each segment three slides were made. These slides were stained by Verhoeff and Weighert's resorcin-fuchsin and used for immunohistochemistry. The elastic compound was measured by colorimetric software analysis. RESULTS: In Verhoeff and Weighert's resorcin-fuchsin, the intermediate and deep layer showed values higher than those of the superficial layer. The amount of tropoelastin identified by the antibody at the superficial layer was close to those of intermediate and deep layer. CONCLUSION: Immunohistochemistry is a method that can identify and measure all forms of elastic fibers at human vocal fold.

Adult↗
PubMed1999

Traumatic myositis ossificans of the superior belly of the omohyoid.

The first case of traumatic myositis ossificans (TMO) involving a strap muscle of the neck is reported. TMO typically presents with an unresolved mass following trauma or surgery, requiring differentiation from other soft tissue and bone neoplasms. Opacification may be present on soft tissue X-rays. Computed tomography (CT) scan may demonstrate a characteristic zoning phenomenon to establish the diagnosis. The disorder is frequently self-limiting but surgery may be required for persistent symptoms.

Adult↗
PubMed2005

More data on major depression as an antecedent risk factor for first onset of chronic back pain.

BACKGROUND: Few epidemiological studies have examined the temporal relationship between chronic pain and depression using longitudinal data. In the present study, we examined major depression as both an antecedent risk factor and consequence of chronic back pain (CBP) in the general population. METHOD: Data on 9909 pain-free individuals 15 years and older with no history of back problems were drawn from cycle 1 of the National Population Health Survey and followed up 24 months later. Major depression was assessed using a structured diagnostic interview. RESULTS: At cycle 2, the rate of new cases of CBP in persons who were depressed at cycle 1 was 3.6% compared to 1.1% in non-depressed persons. Compared to pain-free individuals, new cases of CBP were more likely to perceive their health status as poor or fair at cycle 1, were less likely to be working, reported more chronic health problems, and sustained a back or neck injury in the preceding 12 months. After controlling for other factors, pain-free individuals diagnosed as major depressed at cycle 1 were almost three times more likely (OR 2.9, 95% CI 1.2-7.0) to develop CBP at cycle 2. CONCLUSIONS: Consistent with other longitudinal studies major depression increases the risk of developing future chronic pain. The causal mechanism linking these conditions is unknown however depression may represent a modifiable risk factor in the development of CBP.

Adolescent↗
PubMed2000

Vertebral artery dissection: warning symptoms, clinical features and prognosis in 26 patients.

BACKGROUND AND OBJECTIVES: Internal carotid artery dissection has been extensively studied and well-described. Although there has been a recent increase in the number of reported cases of vertebral artery (VA) dissection, the clinical variety of presentation and the early warning symptoms have not been well-described before. Our objectives in this study include: (1) To determine the early symptoms and warning signs which may help the clinician in the early identification and treatment of patients with VA dissection. (2) To explore the variety of clinical presentation of VA dissection and its relation to prognosis. DESIGN AND SETTING: Retrospective analysis of hospital records in a tertiary academic centre for the period 1989-1999. RESULTS: Twenty-six patients were identified (13 men and 13 women). The mean age was 48. Possible precipitating factors were identified in 14 patients (53%). Sporting activity and chiropractic manipulations were the most common (15% and 11% respectively). Headache and/or neck pain was the prominent feature in 88% of patients and was a warning sign in 53%, preceding onset of stroke by up to 14 days. The most common clinical features included vertigo (57%), unilateral facial paresthesia (46%), cerebellar signs (33%), lateral medullary signs (26%) and visual field defects (15%). Bilateral VA dissection presented in six patients (24%). The most common region of dissection was the C1-C2 level (16 arteries, 51%). Intracranial VA dissection was found in eight arteries (25%). The majority of patients (83%) had favorable outcome. Poor prognosis was associated with (1) bilateral dissection; (2) intracranial VA dissection accompanied by subarachnoid hemorrhage. Only two patients reported stroke recurrence. CONCLUSIONS: Our findings show that VA dissection affects mainly middle age persons and involves both sexes equally. Headache and/or neck pain followed by vertigo or unilateral facial paresthesia is an important warning sign that may precede onset of stroke by several days. Although the majority of patients will have excellent prognosis, this was less likely in patients presenting with subarachnoid hemorrhage or bilateral VA dissection. Recurrence rate was low.

Adult↗
PubMed2004

Persistent idiopathic unilateral isolated hypoglossal nerve palsy: a case report.

Isolated hypoglossal nerve palsy (IHNP) although a rare condition, has been previously reported. A literature review revealed that in most cases, IHNP indicates the presence of an intracranial or extracranial space occupying lesion, head and neck injury, vascular abnormality, infection, autoimmune disease or neuropathy. Reports of idiopathic cases are rare and the vast majority of IHNP are reversible. We report a case of persistent idiopathic unilateral hypoglossal nerve palsy, with an emphasis on the investigations necessary to be undertaken on presentation of such a lesion.

Adult↗
PubMed1998

Bone marrow transplantation from a cadaveric donor.

A 2.5-year-old girl with neurogenic Gaucher's disease was transplanted with donor bone marrow from her HLA-compatible 12-year-old brother whose marrow was harvested 30 min post-mortem, after he suffered a severe head and neck injury. The marrow was stored in liquid nitrogen for 30 days prior to infusion. The post-transplantation period was uneventful with good engraftment and no signs of graft-versus-host disease. Currently, 6 months post-allogeneic bone marrow transplantation (alloBMT), analysis of both bone marrow and blood samples by PCR documented only cells of donor origin. This case demonstrates the feasibility of cadaveric marrow as a source of donor cells. To our knowledge, this patient is the only survivor of alloBMT from a cadaveric donor.

Bone Marrow Transplantation↗
PubMed1999

Use of breath-activated Patient Controlled Analgesia for acute pain management in a patient with quadriplegia.

We report the use of breath-activated Patient Controlled Analgesia (PCA) for the provision of analgesia in a quadriplegic patient with traumatic neck injury. This provided good pain relief, decreased opioid complications, improved perceptions of self-control, smoothed recovery and enhanced patient, family as well as staff satisfaction. The setup and principles of its use in a patient with high anxiety and unable to use conventionally activated PCA are illustrated.

Acute Disease↗
PubMed2003

Development of an evidence-based guideline for imaging in cervical spine trauma.

Cervical spine trauma is a common reason for presentation to an emergency department. However, less than 5% of patients who have suffered possible neck injury actually have an injury requiring medical treatment. Nevertheless, the consequences, both for the patient and the doctor, of a missed injury are well recognized by emergency department medical staff. This results in the vast majority of these patients receiving some form of diagnostic imaging. We describe the development of an evidence-based imaging guideline for use in the patient who has suffered cervical spine trauma. The guideline aims to help clinicians determine, at the bedside, when it is appropriate to use imaging and which imaging modality should be used first. Correct utilization of the guideline should lead to a reduction in the number of imaging tests required to reach a diagnosis without adverse patient outcomes.

Cervical Vertebrae↗
PubMedDate not supplied

Extratrigeminal episodic paroxysmal hemicrania. Further clinical evidence of functionally relevant brain stem connections.

A woman, aged 59 years, developed a constant, left, occipital headache associated with episodes of discrete exacerbations occurring three to five times daily for 3 days, each lasting 15 to 20 minutes, and associated with left ptosis, conjunctival injection, and redness of the left ear. Pain-free remissions, which usually lasted 2 weeks, ceased after a mild neck injury, but the headaches responded promptly to indomethacin. This case, illustrating a transition from an occipital episodic to chronic paroxysmal hemicrania, is discussed as a variation of the trigeminal-autonomic cephalalgias.

Female↗
PubMed1999

Simultaneous fracture-dislocations of the distal and proximal interphalangeal joints.

Sixteen cases of simultaneous fracture-dislocations of both the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints in the same finger that were treated during the past 10 years were classified into three types: the swan-neck injury (dorsal fragment of the base of the distal phalanx at the DIP joint and palmar fragment of the base of the middle phalanx at the PIP joint); the double-hyperextension injury (palmar fragments at the DIP and PIP joints); and the straight-finger injury (with dorsal and palmar bone fragments at the DIP joint). The results of treatment were more satisfactory in PIP joints than in DIP joints.

Adolescent↗
PubMed2002

Manual therapy for mechanical neck disorders: a systematic review.

Neck disorders are common, disabling and costly. Randomized trials were reviewed using a Cochrane format, to determine if manual therapy improves pain, function and patient satisfaction in adults suffering from neck disorders with and without radicular findings or headache. Sequenced computerized searches ended in December 1997. Two independent reviewers extracted data while three assessed trial quality. Standard mean difference and relative risks were translated to number needed to treat (NNT) and the percent treatment advantage. The 20 selected trials' quality was 2.4 (SD: 1.04) on the 5-point scale described by Jadad. Trials were clinically heterogenous. Manipulation alone, mobilizations alone, manipulation/mobilization and treatments including massage consistently showed similar effects to placebo, wait period or control. Multimodal manual therapy care including exercise were superior to a control, to certain physical medicine methods and to rest for pain and patient satisfaction. The NNT for a clinically important reduction in pain varied from 2 to 11 and treatment advantage from 6% to 41% at the cost of benign transient side-effects. While results remain inconclusive, some clinical themes have emerged. For mechanical neck disorder with or without headache, it appears that to be most beneficial, manual therapies should be done with exercise for improving pain and patient satisfaction. Manipulation and mobilization alone appear to be less effective. Factorial design would help delineate the magnitude of effect for each component of care.

Adult↗
PubMed2006

When and how to investigate the patient with headache.

The very common symptom of headache most often has a benign cause and can usually be diagnosed following a thorough history and neurologic and focused general physical examinations. Because the potential etiologies can threaten life and neurological function, headaches provoke understandable concern on the part of the patient and health care provider. Thoughtful testing can exclude the worrisome underlying causes. This article reviews the neurological and general symptoms and signs that should prompt diagnostic testing and the specific diagnostic studies that are recommended. The worrisome factors include recent head or neck injury; a new, worse, worsening, or abrupt-onset headache; headache brought on by exertion or Valsalva maneuver/cough; new headache in the patient over the age of 50; neurological symptoms and/or abnormal signs; systemic symptoms and/or signs; and secondary risk factors such as a history of cancer or human immunodeficiency virus infection. Less worrisome are headaches that wake the patient from sleep at night, side-locked headaches, and prominent effect of change in posture on the pain. The diagnostic investigations include neuroimaging, cerebrospinal fluid examination, and blood testing in specific situations.

Age Factors↗
PubMed1986

[Diagnosis of instability of the upper cervical spine by functional computed tomography].

The evaluation by means of functional x-rays, of rotatory instability of the upper cervical spine as a result traumatic or inflammatory destruction of the ligamentous apparatus, is unsatisfactory. Functional CT of the upper cervical spine allows measurement of the segmental rotatory movements. 9 healthy adults and 30 patients were examined after neck injury via functional CT's. A rotation between occiput and atlas greater than 9 degrees, between atlas and axis over 50 degrees, the left-right difference at the level C0/C1 greater than 6 degrees and at the level C1/C2 over 10.5 degrees point to a suspicion of hypermobility or instability.

Adolescent↗
PubMedDate not supplied

The use and role of sport chiropractors in the national football league: a short report.

OBJECTIVE: To analyze chiropractic utilization on National Football League (NFL) medical teams and the role played by chiropractors. DESIGN: Postal survey of head athletic trainers of the 36 teams. Survey questions were developed from responses to a questionnaire submitted to a pilot group of 30 sport chiropractors and a panel of 20 postdoctoral faculty of the sport chiropractic program of the American Chiropractic Board of Sport Physicians, as well as a representative from the University of South Alabama. RESULTS: Twenty-two of 36 questionnaires were returned for a return rate of 66%. Of the trainers who did respond, 45% have personally been treated by a chiropractor, and 55% have not. Seventy-seven percent of the trainers have referred to a chiropractor for evaluation or treatment, and 23% have not. Thirty-one percent of NFL teams use a chiropractor in an official capacity on their staffs, and 69% do not. When asked to identify conditions appropriate for referral to a chiropractor, the respondents identified low back pain (61%), "stingers" and "burners" usually associated with neck injury (31%), headaches (8%), asthma or other visceral disorders (0%). All respondents (100%) agree that some players use chiropractic care without referral from team medical staff. CONCLUSION: There is significant chiropractic participation in US professional football. Certified athletic trainers see a role for the sport chiropractor in the NFL, primarily as a spinal specialist treating low back and other musculoskeletal injuries. A substantial majority of NFL trainers have developed cooperative relationships with chiropractors, with 77% having referred a player to a chiropractor. Thirty-one percent of NFL teams have a chiropractor officially on staff, and an additional 12% of teams refer players to chiropractors but do not directly retain these chiropractors.

Chiropractic↗
PubMed2003

Acute spinal cord injury in pregnancy: an illustrative case and literature review.

Acute trauma is not all that uncommon in pregnancy. It accounts for 15% of non-obstetric maternal deaths. Moreover, about 15% of acute spinal cord injuries involve young women of childbearing age (Gilson et al., 1995). Most of the existing literature on spinal cord injury in pregnancy is concerned with the management of patients with pre-existing lesions; very few articles deal with acute injuries. We report the management of a case of acute spinal cord injury in the third trimester of pregnancy and review the major clinical issues associated with such cases.

Adult↗
PubMed1990

Diagnosis and treatment of TMJ, head, neck and asthmatic symptoms in children.

The normal physiologic tension of the TMJ muscles, fascia, ligaments, and associated structures is critical for the health of children. Pathologic strain patterns in the soft tissues can be a primary cause of headaches, neckaches, throat infections, ear infections, sinus congestion, and asthma. This article presents effective diagnostic and treatment modalities from both dental and physical therapy viewpoints to relieve and restore normal physiology to the TMJ muscles, fascia, ligaments, and associated structures. As structural balance is restored, a nutritional component of therapy is strongly recommended for the child's optimum health.

Asthma↗