-
The Journal of Spinal Cord Medicine Mar 2017Brachial plexus injuries are usually severe and involve the entire brachial plexus, sometimes occurring with root avulsions. Imaging and electrodiagnostic studies are an...
OBJECTIVE
Brachial plexus injuries are usually severe and involve the entire brachial plexus, sometimes occurring with root avulsions. Imaging and electrodiagnostic studies are an essential part of the lesion evaluation; however, the results sometimes show a discrepancy. The cutaneous silent period (SP) is a spinal inhibitory reflex mediated by small-diameter A-delta nociceptive fibers. The aim of the study was to determine if cutaneous SP testing may serve as a useful aid in evaluation of brachial plexus injury and/or in the diagnosis of root avulsion.
METHODS
In 19 patients with traumatic brachial plexus injury (15 males, age 18-62 years) we performed a clinical examination, CT myelography and neurophysiological testing. A needle EMG was obtained from muscles supplied by C5-T1 myotomes. Cutaneous SP was recorded after painful stimuli were delivered to the thumb (C6 dermatome), middle (C7) and little (C8) fingers while subjects maintained voluntary contraction of intrinsic hand muscles.
RESULTS
Electrodiagnostic and imaging studies confirmed root avulsion (partial or total) maximally involving C5, C6 roots in 12 patients, whereas only in 4 of them the cutaneous SP was partially absent. In the remaining subjects, the cutaneous SP was preserved.
CONCLUSION
In brachial plexopathy even with plurisegmental root avulsion, the cutaneous SP was mostly preserved. This method cannot be recommended as a reliable test for diagnosis of single root avulsion; however, it can provide a quick physiological confirmation of functional afferent A-delta fibers through damaged roots and/or trunks. The clinicians may add this test to the diagnosis of spinal cord dysfunction.
Topics: Adolescent; Adult; Brachial Plexus; Brachial Plexus Neuropathies; Electromyography; Female; Humans; Male; Middle Aged; Muscle Contraction; Radiculopathy; Reaction Time; Reflex
PubMed: 26312387
DOI: 10.1179/2045772315Y.0000000053 -
Korean Journal of Women Health Nursing Dec 2011This study was conducted to analyze and clarify the concept of the effective breastfeeding.
PURPOSE
This study was conducted to analyze and clarify the concept of the effective breastfeeding.
METHODS
This study used Walker and Avant's process of concept analysis.
RESULTS
Effective breastfeeding is how to give infant adequate milk, which fulfills needs of mother and infant, from her breast so that they can be satisfied with the process and results. It included the effective breastfeeding properties as follows: feeding behaviors (positioning, latch on, and suckling), transferring a breast milk to an infant, mother-infant interaction, and satisfying their desires (satisfaction, comfort, mother's self-confidence, infant's adequate weight gain and defecation, adequate breastfeeding interval). The antecedent of effective breastfeeding were anatomical and functional normal breast, breastfeeding knowledge and steady-state of mother, and feeding desire, rooting reflex and normal oral cavity of infant. The consequences of effective breastfeeding were exclusive breastfeeding, infant and maternal health and wellbeing, and achievement of mother and infant attachment.
CONCLUSION
The meaning of effective breastfeeding defined in this study will contribute to develop the effectiveness breastfeeding assessment tool and the nursing intervention for ineffective breastfeeding.
PubMed: 37697536
DOI: 10.4069/kjwhn.2011.17.4.317 -
Journal of Medical Case Reports Aug 2022Owing to the aging population, fragility fractures of the pelvis are occurring more frequently. Fixation of the fracture and stabilization of the pelvic ring usually...
BACKGROUND
Owing to the aging population, fragility fractures of the pelvis are occurring more frequently. Fixation of the fracture and stabilization of the pelvic ring usually provide good clinical results. A case of distal sacral nerve roots severed by a fragility fracture of the sacrum is presented.
CASE PRESENTATION
A 62-year-old Japanese woman with schizophrenia with low back pain, gait disorder, dysuria, and fecal incontinence presented to an emergency department, and plain X-rays showed no findings. She also complained of dysuria, and neurogenic bladder and cystitis were diagnosed. One month later, she was admitted to a psychiatric hospital for exacerbation of schizophrenia. In hospital, she had a urethral catheter inserted and spent 3 months in bed. She was referred to our orthopedic department because a gait disorder was discovered after her mental condition improved and she was permitted to walk. On examination, she could not walk and had decreased sensation from the buttocks to both posterior thighs and around the anus and perineum. Manual muscle testing of her lower limbs showed mild weakness of about 4 in bilateral flexor hallucis longus and gastrocnemius, and bilateral Achilles tendon reflexes were lost. Her anal sphincter did not contract, and urinary retention continued after urethral catheter removal. Imaging examinations showed an H-shaped sacral fracture consisting of a transverse fracture with displacement of the third sacral vertebra and vertical fractures of the bilateral sacral wings, with severe stenosis of the spinal canal at the site of the transverse fracture. The patient was diagnosed as having bladder and rectal dysfunction due to a displaced, unstable sacral fracture. First to third sacral laminectomy and alar-iliac fixation using percutaneous pedicle screws and sacral alar-iliac screws were then performed. The bilateral distal sacral nerve roots (S3, S4, S5) were completely severed at the second to third sacral levels, but bilateral second sacral nerve roots were not compressed from the bifurcation to the sacral foramen. Postoperatively, bladder and rectal dysfunction remained, but the low back pain was alleviated. Two weeks postoperatively, she could walk with a walker and was discharged. Three months after the operation, bone fusion of the fracture was observed.
CONCLUSIONS
In cases of bladder-rectal dysfunction with low back pain, the possibility of sacral fracture should be considered, and computed tomography, magnetic resonance imaging, and X-ray examinations should be performed. Even sacral fractures without displacement require attention because they can cause serious injury in the event of a nerve root being severed if not diagnosed early and given appropriate treatment.
Topics: Aged; Dysuria; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Low Back Pain; Middle Aged; Pelvis; Sacrum; Spinal Fractures
PubMed: 35996162
DOI: 10.1186/s13256-022-03551-z -
Journal of Spine Surgery (Hong Kong) Mar 2024Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or... (Review)
Review
Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or stiffness of the neck, and difficulty walking due to loss of balance. Brachial plexus (BP) neuropathies arise due to compression to any distal branches arising from C5-T1, whereas cervical radiculopathy involves compression at the nerve root in the neck. Such conditions can present with variable degrees of musculoskeletal pain, weakness, sensory changes, and reflex changes. The pronounced convergence in symptomatic manifestation within these conditions can pose a formidable challenge to clinicians, particularly in primary care. Thus, the primary objective of this paper is to enhance clarity and distinction among these pathological conditions. This objective is pursued through comprehensive delineation of the dermatomal and myotomal distributions characteristic of each condition. Furthermore, a meticulous examination is undertaken to elucidate physical indicators and maneuvers that exhibit a notably high sensitivity in detecting these conditions. Accurate diagnosis and treatment of each nerve pathology is important as long-term spinal cord compression and its roots may result in permanent disability and severely impact one's quality of life. As such, this systematic review serves as a guide that aids clinicians in differentiating the aforementioned conditions based on anatomy, physical exam findings, and imaging studies. Furthermore, this study aims to outline common peripheral nerve neuropathies in the upper extremities and ways to mitigate these pathologies using the least to most invasive treatment modalities.
PubMed: 38567008
DOI: 10.21037/jss-23-39 -
The Journal of Physiology May 19981. Paralysis of the diaphragm in the dog causes a non-vagal, non-chemical increase in the activity of the inspiratory intercostal muscles. In the present studies, the...
1. Paralysis of the diaphragm in the dog causes a non-vagal, non-chemical increase in the activity of the inspiratory intercostal muscles. In the present studies, the hypothesis was tested that phrenic afferent fibres may elicit a reflex inhibition of inspiratory intercostal activity. 2. The electrical activity of the three groups of inspiratory intercostal muscles (parasternal intercostals, external intercostals, levator costae) was recorded in twenty vagotomized, spontaneously breathing dogs, and the proximal end of one or both C5 phrenic nerve roots was stimulated during inspiration. 3. Stimulation of the ipsilateral and contralateral C5 phrenic roots caused an immediate reduction in inspiratory intercostal activity. This reduction was abolished when phrenic stimulation was repeated after section of the C5 dorsal roots. 4. The reduction in external intercostal and levator costae activity during bilateral C5 afferent stimulation appeared when the stimulus strength was 3 times the motor threshold and it increased in magnitude when stimulus intensity was increased further. In contrast, the reduction in parasternal intercostal activity occurred only when the stimulus strength was 12 times the motor threshold. 5. These observations confirm the hypothesis that diaphragmatic receptors may reflexly inhibit efferent activity to the inspiratory intercostal muscles, in particular the external intercostals and levator costae. This inhibition appears to be primarily mediated by small myelinated fibres.
Topics: Animals; Diaphragm; Dogs; Electric Stimulation; Electromyography; Intercostal Muscles; Neurons, Afferent; Phrenic Nerve; Reflex; Respiration; Spinal Nerve Roots
PubMed: 9518742
DOI: 10.1111/j.1469-7793.1998.919bp.x -
California Medicine Nov 1958Whiplash injury may extend far beyond the neck, and may involve even the soft tissues of the pelvis. For permanent recovery, all the injuries must be evaluated and...
Whiplash injury may extend far beyond the neck, and may involve even the soft tissues of the pelvis. For permanent recovery, all the injuries must be evaluated and treated together. When impact from the rear snaps the head back and then forward, posterior subluxations in the cervical spine cause anterior-posterior narrowing of the intervertebral foramina, which may result in injury to the cervical nerve roots. Impact at the front, causing hyperflexion followed by hyperextension, has a similar effect although usually not as severe. Resulting symptoms may not appear until two or three weeks later, when irritative lesions have developed because of hemorrhage or swelling. Mild or progressive degenerative changes may cause no symptoms but may predispose the affected area to injury following some slight trauma. Capsular ligaments of the lateral intervertebral joints are especially liable to whiplash injury which may give rise to scars and adhesions that compress spinal nerves. Sympathetic system involvement may cause reflex and referred pain. Detailed neurologic, roentgen and electromyographic studies may be necessary for proper evaluation of injuries. Seemingly psychosomatic pain or disability is likely to have some physical basis in whiplash injuries. In 33 patients with whiplash injury, some recently injured and some chronically disabled with persistent symptoms, good results were observed following hydromassage, hot packs, joint mobilization exercises and, in a few, cervical or pelvic traction.
Topics: Accidents; Accidents, Traffic; Back; Cervical Vertebrae; Cicatrix; Disease; Head; Humans; Neck; Neck Injuries; Pain, Referred; Pelvis; Spinal Diseases; Spinal Nerve Roots; Spine; Whiplash Injuries
PubMed: 13585155
DOI: No ID Found -
Journal of Mathematical Biology Apr 2023The ability of a chemical reaction network to generate itself by catalyzed reactions from constantly present environmental food sources is considered a fundamental...
The ability of a chemical reaction network to generate itself by catalyzed reactions from constantly present environmental food sources is considered a fundamental property in origin-of-life research. Based on Kaufmann's autocatalytic sets, Hordijk and Steel have constructed the versatile formalism of catalytic reaction systems (CRS) to model and to analyze such self-generating networks, which they named reflexively autocatalytic and food-generated. Recently, it was established that the subsequent and simultaenous catalytic functions of the chemicals of a CRS give rise to an algebraic structure, termed a semigroup model. The semigroup model allows to naturally consider the function of any subset of chemicals on the whole CRS. This gives rise to a generative dynamics by iteratively applying the function of a subset to the externally supplied food set. The fixed point of this dynamics yields the maximal self-generating set of chemicals. Moreover, the set of all functionally closed self-generating sets of chemicals is discussed and a structure theorem for this set is proven. It is also shown that a CRS which contains self-generating sets of chemicals cannot have a nilpotent semigroup model and thus a useful link to the combinatorial theory of finite semigroups is established. The main technical tool introduced and utilized in this work is the representation of the semigroup elements as decorated rooted trees, allowing to translate the generation of chemicals from a given set of resources into the semigroup language.
Topics: Catalysis
PubMed: 37071214
DOI: 10.1007/s00285-023-01899-4 -
Experimental Neurobiology Apr 2022Spontaneous interneuron activity plays a critical role in developing neuronal networks. Discharges conducted antidromically along the dorsal root (DR) precede those from...
Spontaneous interneuron activity plays a critical role in developing neuronal networks. Discharges conducted antidromically along the dorsal root (DR) precede those from the ventral root's (VR) motoneurons. This work studied whether spinal interneurons project axons into the neonate's dorsal roots. Experiments were carried out in postnatal Swiss-Webster mice. We utilized a staining technique and found that interneurons in the spinal cord's dorsal horn send axons through the dorsal roots. In vitro electrophysiological recordings showed antidromic action potentials (dorsal root reflex; DRR) produced by depolarizing the primary afferent terminals. These reflexes appeared by stimulating the adjacent dorsal roots. We found that bicuculline reduced the DRR evoked by L5 dorsal root stimulation when recording from the L4 dorsal root. Simultaneously, the monosynaptic reflex (MR) in the L5 ventral root was not affected; nevertheless, a long-lasting after-discharge appeared. The addition of 2-amino-5 phosphonovaleric acid (AP5), an NMDA receptor antagonist, abolished the MR without changing the after-discharge. The absence of DRR and MR facilitated single action potentials in the dorsal and ventral roots that persisted even in low Ca2+ concentrations. The results suggest that firing interneurons could send their axons through the dorsal roots. These interneurons could activate motoneurons producing individual spikes recorded in the ventral roots. Identifying these interneurons and the persistence of their neuronal connectivity in adulthood remains to be established.
PubMed: 35673998
DOI: 10.5607/en21019 -
Child Neurology Open 2022We present a case of a 3-year-old girl who rapidly developed bilateral facial palsy, dysphagia, dysphonia, areflexia, and ataxia soon after receiving an influenza...
We present a case of a 3-year-old girl who rapidly developed bilateral facial palsy, dysphagia, dysphonia, areflexia, and ataxia soon after receiving an influenza vaccine. Brain and spine Magnetic resonance imaging (MRI) scans with and without contrast showed enhancement of cranial nerves III, V, VII, and X, as well as the anterior and posterior cervical spinal and cauda equina roots. cerebrospinal fluid (CSF) studies showed white blood cell count of 19 cells/cm, glucose 81 mg/dL, and protein 116 mg/dL, with negative infectious and autoimmune labs. Serum IgM and IgG antibodies against GM1, GD1a, GD1b, GM2, GT1A, GQ1b were negative. The patient was treated with intravenous immunoglobulin, which led to a full recovery. Upon three-month follow-up, her neurologic examination demonstrated normal cranial nerves, reflexes, and gait. Her presentation was most consistent with the acute bulbar palsy plus (ABPp) variant of Guillain-Barré syndrome (GBS), a rare and challenging diagnosis especially in her age group.
PubMed: 35936111
DOI: 10.1177/2329048X221115476 -
Acta Orthopaedica Jun 2010Cauda equina syndrome (CES) is a severe complication of lumbar spinal disorders; it results from compression of the nerve roots of the cauda equina. The purpose of this...
BACKGROUND AND PURPOSE
Cauda equina syndrome (CES) is a severe complication of lumbar spinal disorders; it results from compression of the nerve roots of the cauda equina. The purpose of this study was to evaluate the clinical usefulness of a classification scheme of CES based on factors including clinical symptoms, imaging signs, and electrophysiological findings.
METHODS
The records of 39 patients with CES were divided into 4 groups based on clinical features as follows. Group 1 (preclinical): low back pain with only bulbocavernosus reflex and ischiocavernosus reflex abnormalities. Group 2 (early): saddle sensory disturbance and bilateral sciatica. Group 3 (middle): saddle sensory disturbance, bowel or bladder dysfunction, motor weakness of the lower extremity, and reduced sexual function. Group 4 (late): absence of saddle sensation and sexual function in addition to uncontrolled bowel function. The outcome including radiographic and electrophysiological findings was compared between groups.
RESULTS
The main clinical manifestations of CES included bilateral saddle sensory disturbance, and bowel, bladder, and sexual dysfunction. The clinical symptoms of patients with multiple-segment canal stenosis identified radiographically were more severe than those of patients with single-segment stenosis. BCR and ICR improved in groups 1 and 2 after surgery, but no change was noted for groups 3 and 4.
INTERPRETATION
We conclude that bilateral radiculopathy or sciatica are early stages of CES and indicate a high risk of development of advanced CES. Electrophysiological abnormalities and reduced saddle sensation are indices of early diagnosis. Patients at the preclinical and early stages have better functional recovery than patients in later stages after surgical decompression.
Topics: Adult; Aged; Aged, 80 and over; Decompression, Surgical; Defecation; Early Diagnosis; Female; Humans; Male; Middle Aged; Patient Selection; Penile Erection; Polyradiculopathy; Retrospective Studies; Sensation Disorders; Urination
PubMed: 20443745
DOI: 10.3109/17453674.2010.483985