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PubMed1986

Observations on the innervation of the sternomastoid muscle.

Nine out of fifteen cases having division of the spinal component of the accessory nerve and the upper cervical motor roots as treatment for spasmodic torticollis had residual movements in the sternomastoid of sufficient magnitude to make further surgery necessary before the muscle was effectively paralysed. These observations imply a more complex innervation for the muscle than is to be found in most anatomical texts.

Accessory Nerve↗
PubMed1991

Lower motor neuron degeneration and familial predisposition to colonic neoplasia in two adult siblings.

A previously unreported association between a familial predisposition to colonic neoplasia and familial adult onset lower motor neuron (LMN) degeneration is reported. Two brothers presented at the ages of 53 and 44 years with multiple colonic adenomata and invasive colonic carcinoma respectively. Subsequently both developed a virtually identical pattern of motor neuron disease of progressive muscular atrophy type. At presentation both had LMN weakness affecting predominantly the upper limb and neck muscles. The disease progressed rapidly to involve the lower limb and bulbar musculature and both brothers died after a 15 month course. Necropsy was performed on one brother and showed pathological changes confined to the LMNs with no evidence of involvement of the pyramidal tracts or motor cortex. The combination of these diseases in two brothers may be of importance in the search for genes responsible for familial motor neuron disorders. It is suggested that a genomic search should be directed initially to the vicinity of known colon neoplasia genes, particularly 5q, 17q and 18q.

Adenocarcinoma↗
PubMed1995

Botulinum toxin F in the treatment of torticollis clinically resistant to botulinum toxin A.

Two reports have shown a Japanese preparation of botulinum toxin type F (BTX-F) to be an effective alternative for patients with torticollis who develop clinical resistance to botulinum toxin type A (BTX-A). A group of patients with torticollis, comprising five secondary non-responders and one primary non-responder, were treated with a preparation of BTX-F produced in the UK (Speywood Pharmaceuticals). A low dose of BTX-F (220 mouse units (MU) in total) was given into clinically affected neck muscles, followed six weeks later by an injection of a total of 520 MU. Antibodies to BTX-A (mouse protection assay) were present in all secondary non-responders but not in the primary non-responder. No patients developed atrophy after injection of Dysport BTX-A (40 MU) into the left extensor digitorum brevis muscle whereas pronounced atrophy occurred in all patients after injection of 40 MU of BTX-F into the right extensor digitorum brevis muscle. Three patients improved subjectively after treatment with 220 MU BTX-F and five (all secondary non-responders) after the subsequent dose of 520 MU (two considerably), with reduced Tsui scores, but group scores were only significantly changed after the higher dose. The primary non-responder remained unchanged after both doses of BTX-F. One patient reported mild dysphagia with 520 MU BTX-F. Mean duration of improvement with 520 MU BTX-F was five (range 4-6)weeks. Thus BTX-F provides benefit for BTX-A non-responders with few side effects but for a shorter period than BTX-A, possibly due to relative underdosing. As with BTX-A, biological sensitivity to BTX-F does not necessarily predict a clinical response.

Adult↗
PubMed2001

Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study.

OBJECTIVE: To study the relation between neck pain and work related neck flexion, neck rotation, and sitting. METHODS: A prospective cohort study was performed with a follow up of 3 years among 1334 workers from 34 companies. Work related physical load was assessed by analysing objectively measured exposure data (video recordings) of neck flexion, neck rotation, and sitting posture. Neck pain was assessed by a questionnaire. Adjustments were made for various physical factors that were related or not related to work, psychosocial factors, and individual characteristics. RESULTS: A significant positive relation was found between the percentage of the working time in a sitting position and neck pain, implying an increased risk of neck pain for workers who were sitting for more than 95% of the working time (crude relative risk (RR) 2.01, 95% confidence interval (95% CI) 1.04 to 3.88; adjusted RR 2.34, 95% CI 1.05 to 5.21). A trend for a positive relation between neck flexion and neck pain was found, suggesting an increased risk of neck pain for people working with the neck at a minimum of 20 degrees of flexion for more than 70% of the working time (crude RR 2.01, 95% CI 0.98 to 4.11; adjusted RR 1.63, 95% CI 0.70 to 3.82). No clear relation was found between neck rotation and neck pain. CONCLUSION: Sitting at work for more than 95% of the working time seems to be a risk factor for neck pain and there is a trend for a positive relation between neck flexion and neck pain. No clear relation was found between neck rotation and neck pain.

Cohort Studies↗
PubMed2004

Digastric muscle activities in anoxic infant rats.

The digastric muscle acts for both feeding (including mastication and swallowing) and respiration. In this study, we examined whether or not the muscle activity is detectable during anoxia in developing rats. Rats at 4 different ages, days 5, 10, 16, and 24, were exposed to 100% N2 under pentobarbital or ketamine-xylazine anesthesia, and the electromyograms of digastric muscles (dEMG) and the diaphragm (diaEMG) were examined simultaneously. Prior to the anoxic exposure, at all ages, the dEMG was similar to or less apparent than the diaEMG, which was detected at each inspiratory movement. In anoxia, we first observed dEMG activity, mostly sporadic (days 5 and 10) or mostly tonic (days 16 and 24), when diaEMG activity was temporarily suppressed (we termed it Phase 1). Second, synchronous phasic or tonic dEMG and phasic diaEMG were recorded temporarily before terminal apnea (we termed it Phase 2). These phenomena were also obtained in vagotomized rats (all ages) or in rats injected with the N-methyl-D-aspartate receptor antagonist MK-801 (dizocilpine (5R,10S)-(+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine hydrogen maleate) (days 16 and 24). In conclusion, our results suggest that in anoxia, dEMG activity is detectable during diaEMG suppression in early anoxia, irrespective of the developmental age, the anesthetic (pentobarbital or ketamine-xylazine), vagotomy, or MK-801 injections.

Animals↗
PubMed2004

Renal cell carcinoma: analysis of postoperative recurrence patterns.

PURPOSE: To retrospectively analyze the recurrence patterns of renal cell carcinoma (RCC) and the factors affecting tumor recurrence. MATERIALS AND METHODS: The institutional review board approved this study; patient informed consent was not required. There were 162 men (mean age, 54 years +/- 13 [standard deviation]) and 32 women (mean age, 56 years +/- 11) who had undergone complete surgical resection of RCC. Mean follow-up period was 45 months (range, 7-92 months). In consensus, two radiologists determined the presence or absence of tumor recurrence and recorded the time and sites of tumor recurrence. The relationships between tumor recurrence and tumor factors, including greatest diameter (> or =5 cm or <5 cm), T stage, N stage, stage group, histologic subtype, and nuclear grade, were evaluated by using Kaplan-Meier statistics. RESULTS: Tumor recurred in 41 (21%) patients. The mean time of tumor recurrence was 17 months (range, 3-50 months). Tumor recurred within 2 years after surgery in 34 (83%) patients. Tumor recurrence sites included lung (n = 29), bone (n = 13), the nephrectomy site (n = 7), brain (n = 6), liver (n = 5), mediastinal lymph nodes (n = 5), the contralateral kidney (n = 4), and the neck muscles (n = 2). The recurrence rate was greater for tumors 5 cm or larger than for those smaller than 5 cm, greater for T3a or T3b tumors than for T1 tumors, greater for stage III tumors than for stage I tumors, and greater for tumors with a nuclear grade of 3 or 4 than for those with a nuclear grade of 1 or 2 (P < .05 for all). CONCLUSION: RCC usually recurs within 2 years after surgery, with the lung being the most vulnerable site; greatest tumor diameter, T stage, stage group, and nuclear grade are important factors for recurrence.

Adolescent↗
PubMed1994

Neural crest tumors: I-123 MIBG imaging in children.

PURPOSE: To determine 24- and 48-hour distribution of iodine-123 metaiodobenzylguanidine (MIBG) and to establish an optimized pediatric imaging protocol. MATERIALS AND METHODS: Seventy-seven I-123 MIBG scans obtained in 33 children undergoing evaluation for neural crest tumor were reviewed. RESULTS: Activity in the salivary glands, myocardium, liver, gut, and bladder was demonstrated on almost all scans. Activity was noted in the neck muscles, thyroid gland, and uninvolved adrenal gland in fewer studies. In 20 studies, abnormal uptake was present in the chest or abdomen at 24 and 48 hours, and lesion identification was improved at 48 hours in 12 studies. Detection of skeletal lesions on 14 scans was similar at 24 and 48 hours. Foci of tumor were first detected at I-123 MIBG imaging in nine studies, and in only two patients was tumor involvement initially missed on I-123 MIBG studies. CONCLUSION: Distribution of I-123 MIBG on images in children differs from that in earlier descriptions in adults. Images of the torso at 48 hours after injection are a useful adjunct in detection of lesions.

3-Iodobenzylguanidine↗
PubMed2004

Cold-induced thermogenesis mediated by GABA in the preoptic area of anesthetized rats.

Bilateral microinjections of GABA (300 mM, 100 nl) or the GABA(A) receptor agonist muscimol (100 microM, 100 nl) into the preoptic area (POA) of the hypothalamus increased the rate of whole body O(2) consumption (VO(2)) and the body core (colonic) temperature of urethane-chloralose-anesthetized, artificially ventilated rats. The most sensitive site was the dorsomedial POA at the level of the anterior commissure. The GABA-induced thermogenesis was accompanied by a tachycardic response and electromyographic (EMG) activity recorded from the femoral or neck muscles. Pretreatment with muscle relaxants (1 mg/kg pancuronium bromide + 4 mg/kg vecuronium bromide i.v.) prevented GABA-induced EMG activity but had no significant effect on GABA-induced thermogenesis. However, pretreatment with the beta-adrenoceptor propranolol (5 mg/kg i.v.) greatly attenuated the GABA-induced increase in VO(2) and tachycardic responses. Accordingly, the GABA-induced increase in VO(2) reflected mainly nonshivering thermogenesis. On the other hand, cooling of the shaved back of the rat by contact with a plastic bag containing 28 degrees C water also elicited thermogenic, tachycardic, and EMG responses. Bilateral microinjections of the GABA(A) receptor antagonist bicuculline (500 microM, 100 nl), but not the vehicle saline, into the POA blocked these skin cooling-induced responses. These results suggest that GABA and GABA(A) receptors in the POA mediate cold information arising from the skin for eliciting cold-induced thermogenesis.

Adrenergic beta-Antagonists↗
PubMed2004

Absence of the cholecystokinin-A receptor deteriorates homeostasis of body temperature in response to changes in ambient temperature.

The circadian rhythm of the body core temperature (T(c)) and the effects of changes in ambient temperatures on the homeostasis of T(c) in Otsuka Long Evans Tokushima Fatty (OLETF) rats, which are naturally occurring cholecystokinin (CCK)-A receptor (CCK-AR) gene knockout (-/-) rats, were examined. In addition, the peripheral responses to warming or cooling of the preoptic and anterior hypothalamic region (PO/AH) were determined. The circadian rhythm of T(c) in OLETF rats was similar to that in Long-Evans Tokushima (LETO) rats; this rhythm was characterized by a higher T(c) during the dark period and a lower T(c) during the light period. When the ambient temperature was changed within the limits of 0 degrees C to 30 degrees C, the changes in T(c) of LETO rats were associated with the changes in ambient temperature, whereas those in OLETF rats were dissociated from the temperature changes. The OLETF rats showed a large hysteresis. The peripheral responses to warming or cooling of PO/AH, including shivering of the neck muscle and changes in skin temperature of the tail and footpad, were similar in OLETF and LETO rats. To confirm the role of CCK-AR in the regulation of body temperature, the values of T(c) in the CCK-AR(-/-) mice were compared with those in CCK-B receptor (CCK-BR) (-/-), CCK-AR(-/-)BR(-/-), and wild-type mice. In the mice, the circadian rhythms of T(c) were the same, regardless of the genotype. Mice without CCK-AR showed larger hysteresis than mice with CCK-AR. From these results, we conclude that the lack of CCK-AR causes homeostasis of T(c) in rats and mice to deteriorate.

Animals↗
PubMed1990

No effect of prostaglandin synthesis inhibition on muscle reflexes in fetal lambs.

The effects of inhibiting prostaglandin (PG) synthesis on fetal breathing movements and on the amplitude of reflex contraction of the digastric muscle (five trials) or hindlimb semitendinosus muscle (seven trials) has been studied in six fetal lambs at 123-139 days gestation. Infusion of either indomethacin (100 mg) or acetaminophen (300 mg) in 30 ml saline over 30 min resulted in an increase in the amplitude and incidence of breathing movements for 3-18 h in the different trials, but there was no change in the mean amplitude of either reflex or in the normal variation of reflex amplitude with changes in electrocortical activity. It is concluded that PGs modulate fetal breathing movements by an action on the brain stem chemoreceptors but do not alter the excitability of neural pathways subserving some cranial and spinal reflexes.

Acetaminophen↗
PubMed1992

Effects of temperature and anoxia on regional cerebral blood flow in turtles.

Regional cerebral blood flow (CBF) was measured in isoflurane-anesthetized turtles (Pseudemys scripta) by the hydrogen clearance method. Teflon-coated platinum electrodes (25 microns) were implanted in the olfactory bulbs, midcerebral cortex and cerebellum in eight adult turtles. The electrodes were voltage clamped at +0.30 V relative to a Ag-AgCl electrode implanted in the dorsal neck muscles. Washout kinetics of H2 gas administered via controlled ventilation was used to calculate local blood flow for electrodes exhibiting monoexponential washout kinetics of hydrogen (92 of 104 determinations). Data were obtained in animals with body temperatures of 15, 25, and 35 degrees C under normocapnic conditions during ventilation with 21% O2 and during ventilation with 100% N2. During normoxia, mean blood flows were 1.9 +/- 0.8, 5.0 +/- 1.9, and 6.1 +/- 1.3 (+/- SD) ml.100 g-1.min-1 at 15, 25, and 35 degrees C, respectively. There were no differences between CBF values in the different brain regions. During 1-3 h of anoxia, CBF was 3.0 +/- 2.1, 7.0 +/- 3.7, and 6.6 +/- 2.9 ml.100 g-1.min-1 at 15, 25, and 35 degrees C, respectively (normoxia-anoxia difference not statistically different). Hypercarbia (ventilation with 10-20% CO2 in air or N2), or the transition from anoxia to normoxia, increased CBF up to 80% at each of these temperatures. Maintenance of CBF during anoxia likely contributes to the anoxia tolerance of the turtle brain.

Animals↗
PubMed1984

Pharyngeal airway-stabilizing function of sternohyoid and sternothyroid muscles in the rabbit.

The upper airway is vulnerable to collapse from negative intraluminal pressures during inspiration. The tongue muscles, the genioglossi and geniohyoids, by contracting during inspiration, appear to function to resist this collapse. This study supports the hypothesis that two cervical strap muscles, the sternohyoid and sternothyroid, have a similar function. First, phasic inspiratory electromyographic activity was recorded from the sternohyoid and sternothyroid muscles of nine anesthetized rabbits during tidal breathing. Furthermore, each muscle showed a progressive increase in electromyographic activity with airway occlusion. Second, in eight rabbits, by determining the amount of negative pressure required to collapse the upper airway (airway closing pressure determination), it was shown that upper airway stability improved with electrical stimulation of either the paired sternohyoid or sternothyroid muscles. In addition, in 12 freshly killed rabbits, mechanical tension, mimicking the contraction of either the sternohyoid or sternothyroid, improved airway stability. Finally, observations of the pharyngeal lumen utilizing a fiber-optic endoscope, revealed concentric narrowing of the oro- and nasopharynx when airway pressure was lowered and concentric widening when tension was increased in the sternohyoid or sternothyroid muscles. These findings support the hypothesis that phasic inspiratory contraction of the sternohyoid and sternothyroid muscles functions to resist pharyngeal airway collapse due to negative intraluminal pressures.

Animals↗
PubMed1988

Effect of increased arterial CO2 on fetal breathing and behavior in sheep.

We studied breathing and behavioral response to increased arterial CO2 (PaCO2) in 12 fetal sheep between 130 and 145 days of gestation. Of these 12 fetuses, 10 had an increase in PaCO2 through maternal rebreathing of CO2; in the other 2 fetuses CO2 was increased via an endotracheal tube and application of continuous distending airway pressure. We used our window technique to observe and videotape fetal behavior. The experiments consisted of recording breathing activity and behavior during resting conditions (1 low- and high-voltage ECoG cycle) and during administration of CO2. We measured electrocortical activity (ECoG), eye movements (EOG), electromyography of the diaphragm (EMGdi) and neck muscles, tracheal (Ptr), amniotic, and carotid arterial pressures. Administration of CO2 by the rebreathing technique produced an increase in the amplitude of breathing activity as reflected by an increase in Ptr from 5.0 +/- 0.6 to 12 +/- 1.9 mmHg (P less than 0.01) and an increase in SEMGdi from 32 +/- 4 to 77 +/- 8% max (P less than 0.001). Frequency increased due to a decrease in inspiratory (TI) and expiratory duration. Ptr/TI increased from 11.0 +/- 2.0 to 37.4 +/- 9.0 mmHg/s (P less than 0.05) and SEMGdi/TI increased from 67 +/- 7 to 221 +/- 28% max/s (P less than 0.001). Although the response was at times prolonged into the transitional high-voltage zone, it did not persist during established high-voltage ECoG.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Cervical magnetic stimulation: a new painless method for bilateral phrenic nerve stimulation in conscious humans.

Assessing diaphragmatic contractility is a common goal in various situations. This assessment is mainly based on static or dynamic maximal voluntary maneuvers and twitch transdiaphragmatic pressures (Pdi) obtained by stimulation of the phrenic nerves (PS). PS eliminates the central components of diaphragmatic activation, but the available techniques of PS remain subject to some limitations. Transcutaneous PS is painful, and needle PS is potentially dangerous. Time-varying magnetic fields can stimulate nervous structures without pain and without adverse effects. In six subjects, we have studied cervical magnetic stimulation (CMS) as a method of PS. We have compared the stimulated Pdi (Pdistim) with the maximal Pdi obtained during static combined expulsive-Mueller maneuver (Pdimax) and with the Pdi generated during a sniff test (Pdisniff). CMS produced twitch Pdi averaging 33.4 +/- 9.7 cmH2O. Pdistim/Pdimax and Pdistim/Pdisniff were 24 +/- 6 and 41 +/- 14%, respectively. These values are comparable to those obtained in other studies with transcutaneous PS. They were highly reproducible in all the subjects. Electromyographic data provided evidence of bilateral maximal stimulation. CMS is a nonspecific method and may stimulate various nervous structures. However, diaphragmatic contraction was elicited by stimulation of the phrenic trunk, since the phrenicodiaphragmatic latencies (less than 7 ms) were in the range of values reported with direct stimulation of the trunk. Cocontraction of neck muscles, including the sternomastoid, was present, but its influence in the CMS-induced Pdi seems minimal. We conclude that magnetic stimulation is an easy, well-tolerated, reproducible safe, and valuable method to assess phrenic conduction and diaphragmatic twitch response.

Action Potentials↗
PubMed1998

Rib cage muscle interaction in airway pressure generation.

We have previously demonstrated in dogs that the change in airway opening pressure (DeltaPao) produced by isolated maximum activation of the parasternal intercostal or triangularis sterni muscle in a single interspace, the sternomastoids, and the scalenes is proportional to the product of muscle mass and the fractional change in muscle length per unit volume increase of the relaxed chest wall. In the present study, we have assessed the interactions between these muscles by comparing the DeltaPao obtained during simultaneous activation of a pair of muscles (measured DeltaPao) to the sum of the DeltaPao values obtained during their separate activation (predicted DeltaPao). Measured and predicted DeltaPao values were compared for the following pairs of muscles: the parasternal intercostals in two interspaces, the parasternal intercostals in one interspace and either the sternomastoids or the scalenes, two segments of the triangularis sterni, and the interosseous intercostals in two contiguous interspaces. For all these pairs, the measured DeltaPao was within approximately 10% of the predicted value. We therefore conclude that 1) the pressure changes generated by the rib cage muscles are essentially additive; and 2) measurements of the mass of a particular muscle and of its fractional change in length during passive inflation can be used to estimate the potential pressure-generating ability of the muscle during coordinated activity as well as during isolated activation.

Air Pressure↗
PubMed1976

Activity of ventrolateral thalamic neurons during arm movement.

1. Monkeys were trained to maintain the handle of a manipulation within a small zone despite perturbations to the handle and to perform slow and rapid arm movements triggered by a visual stimulus. The activity of neurons in the region of the ventrolateral thalamus which projects directly to the arm area of the motor cortex (VL arm area) was then examined during performance of the task and while the animal's limb was passively manipulated. 2. Thalamic units related to arm movement were confined to the VL arm area. Microstimulation (less than 25 muA) in the VL arm area could, in some instances, evoke localized contractions of shoulder, arm, and hand musculature. Thalamic units whose discharge appeared to be related to jaw, tongue, and neck muscle activity occurred only medial to arm movement-related units, and units related to spontaneous leg movements occurred only laterally. 3. Most VL arm area neurons, although well related to active arm movements, were not influenced by gentle passive manipulation of the animal's limb. Few VL arm area neurons responded at short latency to perturbations applied to the handle of the manipulandum which the animal was holding. Thus, VL arm area neurons are unlike many motor cortex arm area neurons which are responsive to passive manipulation and are influenced at short latency by similar perturbations to the animal's limb. 4. Most arm movement-related VL neurons discharge during both fast and slow arm movements. Although a few neurons varied their discharge only during fast movements, none varied only in relation to slow movements. VL arm area neurons are, therefore, unlike the neurons in one source of its input, the globus pallidus, where some neurons are preferentially related to slow movements. 5. Some VL arm area neurons vary their discharge before any change in muscle activity during a fast and slow movement. Such neurons were recorded in VL regions which project to motor cortex areas representing proximal and distal musculature. This suggests that VL neurons might play a role in initiating activity in muscles concerned with controlling body posture, as well as those involved in discrete limb movements.20

Animals↗