Impact of bowel resection on postoperative mortality in patients with obturator hernias.

PURPOSE: The purpose of this study was to identify any potential correlation between postoperative mortality and bowel resection in patients with obturator hernias. METHODS: In total, 21 patients who underwent emergency surgery for a primary incarcerated obturator hernia during a 9-year period were retrospectively assessed regarding the correlation between postoperative mortality within 30 days from surgery and bowel resection. RESULTS: The 21 hernias occurred in 20 women and 1 man. The mean age at presentation was 83.3 years. Eight hernias required bowel resection, and operations using mesh were performed for eight hernias. Complications occurred in association with nine hernias, and three patients died. Postoperative mortality was correlated with complications (p = 0.016) and bowel resection (p = 0.010). Patients undergoing bowel resection had a significantly longer operation time (p = 0.009) and a higher rate of postoperative complications (p = 0.018). The systolic blood pressure, pH, and base excess were significantly lower in patients who did than did not undergo bowel resection (p = 0.017, 0.009, and 0.015, respectively). CONCLUSION: As the aging population continues to expand, the number of patients with obturator hernias is speculated to increase. Elderly people with comorbidities require immediate operative procedures because their general condition tends to be exacerbated by bowel obstruction. Postoperative management may be carefully performed in patients with bowel resection because the postoperative mortality rates may be higher in these patients.

Severe mandibuloacral dysplasia caused by novel compound heterozygous ZMPSTE24 mutations in two Japanese siblings.

Mandibuloacral dysplasia (MAD) is a rare autosomal recessive progeroid syndrome, characterized by mandibular hypoplasia, acroosteolysis affecting distal phalanges and clavicles, delayed closure of the cranial sutures, atrophic skin, and lipodystrophy. Recently, mutations in lamin A/C (LMNA) and zinc metalloprotease (ZMPSTE24), involved in post-translational processing of prelamin A to mature lamin A, have been identified in MAD kindreds. We now report novel compound heterozygous mutations in exon 1 (c.121C>T; p.Q41X) and exon 6 (c.743C>T; p.P248L) in ZMPSTE24 in two Japanese sisters, 7- and 3-year old, with severe MAD and characteristic facies and atrophic skin. The older sister had lipodystrophy affecting the chest and thighs but sparing abdomen. Their parents and a brother, who were healthy, had heterozygous mutations. The missense mutation, P248L, was not found in 100 normal subjects of Japanese origin. The mutant Q41X was inactive in a yeast halo assay; however, the mutant P248L retained near normal ZMPSTE24 activity. Immunoblots demonstrated accumulation of prelamin A in the patients' cell lysates from lymphoblasts. The lymphoblasts from the patients also revealed less intense staining for lamin A/C on immunofluorescence. We conclude that ZMPSTE24 deficiency results in accumulation of farnesylated prelamin A, which may be responsible for cellular toxicity and the MAD phenotype.

The influence of early ambulation and other factors on headache after lumbar myelography.

In order to determine the influence of early ambulation and other factors on headaches occurring after lumbar myelography we randomised 207 patients (127 men and 80 women) into two groups. Following the investigation, we allowed the 101 patients (65 men and 36 women) in group A to sit or stand freely, while we confined the 106 patients (62 men and 44 women) in group B to bed for 20 hours. The nine patients in group B who could not maintain bed rest were excluded. There was no significant difference between the two groups as regards the prevalence of spinal headache (8.9% in group A v 14.4% in group B). Patients who reported headaches, however, were significantly more likely to be women (18.7%) than men (73%), be younger (mean age 45 years v 56 years), have a higher cerebrospinal pressure before removal of fluid (mean values 172 v 137 mm H2O) and a lower systolic (mean values 120 v 134 mmHg) and diastolic blood pressure. We conclude that, although other factors may be associated with headaches, late ambulation is not effective in preventing spinal headaches after lumbar myelography.

Differential screening-selected gene aberrative in neuroblastoma protein modulates inflammatory pain in the spinal dorsal horn.

Differential screening-selected gene aberrative in neuroblastoma (DAN) belongs to a novel gene family that includes the Xenopus head-inducing factor, Cerberus and the dorsalizing factor, Gremlin. It has been suggested that members of this family control diverse processes in growth, development and the cell cycle.Here, we demonstrate that the DAN protein is produced in the small neurons of the dorsal root ganglion and is transported to the nerve terminals in the spinal dorsal horn in adult rats. Furthermore, intrathecal injection of an antibody to the DAN protein suppressed inflammatory pain caused by the introduction of complete Freund's adjuvant or carrageenan into the rat hindpaw. The amount of mRNA for DAN in dorsal root ganglion neurons and of its expressed protein in the spinal dorsal horn were both increased in inflammatory models.Together, these data suggest that the DAN protein may be a novel neuromodulator in primary nociceptive nerve fibers.

Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibres.

There have been several reports on the use of extracorporeal shock waves in the treatment of pseudarthrosis, calcifying tendinitis, and tendinopathies of the elbow. However, the pathomechanism of pain relief has not been clarified. To investigate the analgesic properties of shock wave application, we analyzed whether it produces morphologic changes in cutaneous nerve fibres. In normal rat skin, the epidermis is heavily innervated by nerve fibres immunoreactive for protein gene product (PGP) 9.5 and by some fibres immunoreactive for calcitonin gene-related peptide (CGRP). There was nearly complete degeneration of epidermal nerve fibres in the shock wave-treated skin, as indicated by the loss of immunoreactivity for PGP 9.5 or CGRP. Reinnervation of the epidermis occurred 2 weeks after treatment. These data show that relief of pain after shock wave application to the skin results from rapid degeneration of the intracutaneous nerve fibres.

[Relationship between flow volume curve and CT findings in non-smoking patients with long histories of bronchial asthma].

AIM: This study was conducted to verify whether bronchial asthma (BA) alone causes pulmonary emphysema (PE), and to examine the computed tomography (CT) findings in non-smokers with BA demonstrating the flow volume curve (FV curve) characteristic of PE. SUBJECTS AND METHODS: Non-smoking patients with a history of BA for more than 20 years were divided into 2 groups: the dogleg pattern group (n = 5), with an FV curve characteristic of PE, and the concave pattern group (n = 16) with an FV curve characteristic of BA. CT scans was performed using CT values (level, 900 H.U.; width, 400 H.U.) that facilitate detection of a low attenuation area (LAA), and using conventional CT values (level, 700 H.U.; width, 1,300 H.U.). LAA (including air trapping), thickness of the bronchial wall, and partial atelectasis were compared between the 2 groups. RESULTS: PE was not detected, although air trapping was found in all subjects. The thickness of the airway was greater in the dogleg pattern than in the concave pattern. The incidences of air trapping and partial atelectasis were higher in the former than in the latter. DISCUSSION: BA alone may not cause PE. Some BA patients without PE show the FV curve characteristic of PE, reflecting an increase in the thickness of the airway wall and a decrease in the pulmonary ventilation probably due to the air trapping and the partial atelectasis.

Using cineradiography for continuous dynamic-motion analysis of the lumbar spine.

STUDY DESIGN: Cineradiography was used to analyze continuous dynamic motion in the lumbar spine. OBJECTIVES: To identify motion patterns of the lumbar spine in asymptomatic volunteers and symptomatic patients with L4 degenerative spondylolisthesis, and to use the findings to discuss segmental instability in this disorder. SUMMARY OF BACKGROUND DATA: The use of radiographic findings to assess lumbar spine instability remains controversial. Although some studies have reported on lumbar kinematics during actual movement, the motion patterns in asymptomatic volunteers and symptomatic patients with L4 degenerative spondylolisthesis have not been fully clarified. METHODS: While asymptomatic volunteers (n=20; mean age, 27; control group) and symptomatic patients with L4 degenerative spondylolisthesis (n=41; mean age, 63; degenerative spondylolisthesis [DS] group) flexed from a sitting neutral position and back to the neutral position (flexion course), cineradiography was used to record lateral segmental lumbar motions. Twelve frames were selected during the flexion course, and flexion-extension angle (f-e angle) and translation in the sagittal plane were measured at each motion segment (L2-L3, L3-L4, L4-L5, and L5-S1). The DS group was classified into 2 subgroups according to percentage of slip: DS group I, with a slip equal to or less than 15%; and DS group II, with a slip of more than 15%. The motion pattern was compared between the groups. RESULTS: In the control group, f-e angle and translation at the L2-L3, L3-L4, and L4-L5 segments moved simultaneously, although the L5-S1 segment showed an initial delay. The amount of f-e angle and translation changed almost symmetrically. In both f-e angle and translation, the L4-L5 segment showed a large motion pattern. In DS group I (n=21), the L4-L5 segment showed a large motion pattern in f-e angle and an intermediate motion pattern in translation. In DS group II (n=20), the L4-L5 segment showed an intermediate motion pattern in f-e angle, and a small motion pattern in translation. The relative range of f-e angle at the L4-L5 segment had the largest range in DS group I, and the relative translation showed a serial decrease from the control group through DS group II. A significant correlation between f-e angle and translation (harmonious motion pattern) was noted at the L2-L3, L3-L4, and L4-L5 segments in the control group. The harmonious motion pattern at the L4-L5 segment was significantly less in the DS group than in the control group. The loss of harmonious motion pattern (disordered motion pattern) at L4-L5 was well-revealed in the DS group II. CONCLUSIONS: Motion analyses using cineradiography helped to explain the phenomena of lumbar spine kinematics. Based on continuous dynamic-motion analysis with cineradiography, large f-e angle and disordered motion pattern during the flexion-backward course in the DS group I was considered to be caused by segmental instability. The decreased translation and disordered motion pattern throughout the flexion course in the DS group II was considered to be caused by restabilization.

Mediastinal neurilemmoma complicated with spinal subarachnoid hemorrhage.

A 28-year-old woman suffered severe back pain and headache during exercising on three occasions during the prior two-month period. On admission, the physical examination revealed symptoms of meningeal irritation, nuchal rigidity, severe headache, continuous nausea, and vomiting. Cerebral computed tomography of the intracranial subarachnoidal space revealed no subarachnoid hemorrhage. Her cerebrospinal fluid was bloody. Spinal magnetic resonance imaging identified a posterior mediastinal tumor adherent to the left side of the 5th thoracic vertebra and an abnormally expanded blood vessel near the mediastinal tumor. In addition, a high signal intensity lesion appeared to be present on the surface of the spinal cord. A mediastinal neoplasm was removed through standard thoracotomy. During surgery, marked enlargement was noted in some veins (hemiazygos and 5th intercostal veins) which apparently had been constricted by the mediastinal tumor. Surgical and radiological findings suggested a relationship between the constricted venous return due to the tumor and the patient's spinal subarachnoid hemorrhage.

Spatial and temporal collagen gene expression in lumbar intertransverse fusion in the rabbit.

We have examined the process of fusion of the intertransverse processes and bone graft in the rabbit by in situ hybridisation and evaluated the spatial and temporal expression of genes encoding pro-alpha1 (I) collagen (COL1A1), pro-alpha1 (II) collagen (COL2A1) and pro-alphal (X) collagen (COL10A1). Beginning at two weeks after operation, osteogenesis and chondrogenesis occurred around the transverse process and the grafted bone at the central portion of the area of the fusion mass. Osteoblasts and osteocytes at the newly-formed woven bone expressed COL1A1. At the cartilage, most chondrocytes expressed COL2A1 and some hypertrophic chondrocytes COL10A1. In some regions, co-expression of COL1A1 and COL2A1 was observed. At four weeks, such expressions for COLlA1, COL2A1 and COL10A1 became prominent at the area of the fusion mass. From four to six weeks, bone remodelling progressed from the area of the transverse processes towards the central zone. Osteoblasts lining the trabeculae expressed a strong signal for COL1A1. At the central portion of the area of the fusion mass, endochondral ossification progressed and chondrocytes expressed COL2A1 and COL10A1. Our findings show that the fusion process begins with the synthesis of collagens around the transverse processes and around the grafted bone independently. Various spatial and temporal osteogenic and chondrogenic responses, including intramembranous, endochondral and transchondroid bone formation, progress after bone grafting at the intertransverse processes. Bone formation through cartilage may play an important role in posterolateral spinal fusion.

[Topics of clinical physiological tests--pulmonary function--proposal of physio-chemical tests].

Pulmonary functions are classified as respiratory and non-respiratory. Although the mechanisms of non-respiratory pulmonary function have already been established, no new tests of respiratory pulmonary function have been developed for a long time. Thus, we report here a new analytic test of respiratory pulmonary functions. The new analytic method is physio-chemical analysis, in which the chemical factors of lungs are estimated from the physiological characteristics of lung during respiration. As examples, this report shows the method of exchanging mechanical energy to chemical energy in a comparison of lung ventilatory work between smokers and non-smokers. This report discusses the relationship between chemical energy and ATP in the blood of pneumoconiosis patients.

Clinicopathological analyses of advanced colorectal cancers of different sizes--especially those of 20 mm or less in diameter.

BACKGROUND/AIMS: Many small cancers of the flat type can now be detected, and many advanced cancers of the flat type have been discovered. In this study, to clarify the clinicopathological characteristics of small advanced cancers, advanced cancers of 20 mm or less in diameter were compared with those of other sizes. METHODOLOGY: Patients with advanced colorectal cancer (n = 865) were divided into four groups on the basis of cancer diameter as follows: Group A (20 mm or less), 21 patients; Group B (21-60 mm), 581 patients; Group C (61-100 mm), 215 patients; and Group D (101 mm or more), 48 patients. These groups were compared for various clinicopathological findings. RESULTS: The depth of invasion was muscularis propria in 14 cases and subserosa in 7 cases. In Group A, cancer was histologically well-differentiated in 8 cases, moderately differentiated in 12 cases, and mucinous in one case. Six cases (28.6%) in Group A had lymph node metastasis (N1). In Group A, one patient had multiple liver metastasis and all of the other cases were assessed as R0 resection. CONCLUSIONS: Most small advanced colorectal cancers of 20 mm or less in diameter can be regarded as quasi-early cancers, but some have the potential for high malignancy, and for these, reduction surgery cannot be used.

Origin and pathway of sensory nerve fibers to the ventral and dorsal sides of the sacroiliac joint in rats.

The purpose of this study is to clarify sensory innervation in the ventral and dorsal sides of the sacroiliac joint. Fluoro-gold, a neural tracer, was injected into the left sacroiliac joint of adult rats from the dorsal side after denervation of the dorsal side, and the bilateral dorsal root ganglia (DRGs) from T13 to S4 were examined by fluorescence microscopy five days after injection. In another rat group, the DRGs were examined using the same methods after injection of fluoro-gold from the ventral side. In the case of dorsal denervation (ventral nerve supply), labeled neurons were mainly located in the ipsilateral DRGs from L1 to S2. On the other hand, in the case of ventral denervation (dorsal nerve supply), labeled neurons were noted in the ipsilateral DRGs from L4 to S2. The sacroiliac joint in rats is innervated differently on the ventral and dorsal sides: the sensory nerve fibers to the dorsal side of the sacroiliac joint were derived from the DRGs of lower lumbar and sacral levels (from L4 to S2); and those to the ventral side from the DRGs of upper lumbar, lower lumbar, and sacral levels (from L1 to S2).

Hydroxylases involved in vitamin D metabolism are differentially expressed in murine embryonic kidney: application of whole mount in situ hybridization.

In this study we examined the expression of 25-hydroxyvitamin D-1alpha-hydroxylase (1alpha-hydroxylase) and 25-hydroxyvitamin D-24-hydroxylase (24-hydroxylase) by RT-PCR and whole mount in situ hybridization using organ culture of kidney taken from mouse embryo. First, the kidneys of mouse embryo at 11.5-17.5 days gestation were cultured in the presence or absence of forskolin and 1,25-dihydroxyvitamin D(3) [1alpha,25-(OH)(2)D(3)]. Forskolin and 1alpha,25-(OH)(2)D(3) induced the expression of 1alpha-hydroxylase and 24-hydroxylase, respectively, in a dose- and time-dependent manner. In the absence of stimulants, the expression of 1alpha-hydroxylase and 24-hydroxylase was detected from days 13.5-17.5 gestation. The expression of vitamin D receptor and megalin was detected from days 13.5 and 11.5, respectively. Next, signals for the expression of either 1alpha-hydroxylase or 24-hydroxylase were detected by whole mount in situ hybridization in kidney explants taken from embryo at 15.5 days gestation after the appropriate stimulation. However, the localization of signals differed between the two enzymes; 1alpha-hydroxylase messenger RNA was expressed in the inner area of the kidney explants, whereas 24-hydroxylase messenger RNA was expressed in the surface area. The expression of both hydroxylases was restricted to the epithelium of developing renal tubules. The pattern of megalin expression was similar to that of 1alpha-hydroxylase expression. To confirm the difference in distribution of 1alpha-hydroxylase and 24-hydroxylase transcripts, the explants were hybridized with probes for both 1alpha-hydroxylase and 24-hydroxylase using double labeling techniques after simultaneous stimulation with forskolin and 1alpha,25-(OH)(2)D(3), resulting in the detection at different locations of positive signals for the two enzymes. These results suggest that the expression of 1alpha-hydroxylase is induced in a distinct epithelium of renal tubules from that of 24-hydroxylase even at the early stage of kidney development before glomerulogenesis.

Phenotypic inflammation switch in rats shown by calcitonin gene-related peptide immunoreactive dorsal root ganglion neurons innervating the lumbar facet joints.

STUDY DESIGN: The changes in dorsal root ganglion neurons innervating the L5-L6 facet joint were studied using the retrograde neurotransport method and the immunohistochemistry of calcitonin gene-related peptide in an inflammatory model of rats. OBJECTIVES: To determine by inflammatory stimulation the changes in calcitonin gene-related peptide-immunoreactive dorsal root ganglion neurons innervating the L5-L6 facet. SUMMARY OF BACKGROUND DATA: The rat L5-L6 facet joint is innervated from L1-L5 dorsal root ganglia. The presence of calcitonin gene-related peptide-immunoreactive dorsal root ganglion neurons innervating the L5-L6 facet joint has been confirmed, but the changes in the number and distribution of these neurons caused by inflammation have not been studied. METHODS: Retrograde transport of fluorogold was used in 20 rats: 10 in the control group and 10 in the inflammatory group. Using the dorsal approach, fluorogold crystals were injected into the left L5-L6 facet joint. Then 5 days after application, complete Freund's adjuvant (50 microg Mycobacterium butyricum in oil saline emulsion) was injected into the same L5-L6 facet joint (inflammatory group). Of the total fluorogold-labeled dorsal root ganglion neurons from T13-L6, the number and cross-sectional area of the cell profiles of fluorogold-labeled, calcitonin gene-related peptide-immunoreactive neurons in the bilateral dorsal root ganglia of both groups were evaluated. RESULTS: Fluorogold-labeled neurons were distributed throughout the ipsilateral dorsal root ganglia from L1-L5 in both groups. Of the fluorogold-labeled neurons, the ratios of the calcitonin gene-related peptide-immunoreactive L1, L2, L3, L4, and L5 dorsal root ganglion neurons, respectively, were 17%, 24%, 44%, 56%, and 50% in the control group and 50%, 39%, 51%, 61%, and 56% in the inflammatory group. The ratios of the calcitonin gene-related peptide-immunoreactive L1 and L2 dorsal root ganglion neurons labeled by fluorogold were significantly higher in the inflammatory group than in the control group (P < 0.05). The mean cross-sectional area of fluorogold-labeled, calcitonin gene-related peptide-immunoreactive cells from L1-L5 dorsal root ganglia increased from 621 +/- 64 microm2 to 893 +/- 63 microm2 in the inflammatory group (P < 0.01). CONCLUSIONS: The ratio of fluorogold-labeled, calcitonin gene-related peptide-immunoreactive neurons was significantly higher in the L1 and L2 dorsal root ganglia of the inflammatory group than in those of the control group, and the average cross-sectional area of the cells from L1-L5 dorsal root ganglion increased. Associated with the inflammation in the facet joints, the change in calcitonin gene-related peptide-immunoreactive neuron distribution and the phenotypic switch to large neurons may complicate the mechanism of facet joint inflammatory pain.

Sensory innervation of the dorsal portion of the lumbar intervertebral discs in rats.

STUDY DESIGN: The levels of dorsal root ganglions (DRGs) innervating the dorsal portion of the lumbar intervertebral discs from L1-L2 to L4-L5 were investigated in rats by the retrograde transport method. The pathways and functions of nerve fibers supplying the dorsal portion of the discs were investigated by denervation and immuno-histochemistry. OBJECTIVES: To investigate the sensory innervation of the dorsal portion of the lumbar intervertebral discs in rats. SUMMARY OF BACKGROUND DATA: The dorsal portion of the L5-L6 disc has been reported to be innervated multisegmentally, and anesthetic blockade of the paravertebral sympathetic trunks and the L2 spinal nerve can relieve discogenic low back pain. However, sensory innervation of the dorsal portion of the lumbar discs at other levels has not been clarified. METHODS: A retrograde transport of Fluoro-Gold was used. We studied a nonsympathectomy group (n = 44) and a sympathectomy group (n = 50) in which paravertebral sympathetic trunks were resected from L1 to L5 levels. Using a ventral approach, Fluoro-Gold crystals were inserted into the dorsal portion of the L1-L2, L2-L3, L3-L4, and L4-L5 discs. Seven days after surgery, Fluoro-Gold-labeled neurons were counted in the bilateral dorsal root ganglions from T10 to L6. RESULTS: Fluoro-Gold-labeled neurons were distributed in dorsal root ganglions from T11 to L5 levels in the nonsympathectomy group. However, in the sympathectomy group the number of labeled neurons was less than that of the nonsympathectomy group in T11, T12, and T13 dorsal root ganglions of the L1-L2 disc group, in T12, T13, and L1 dorsal root ganglions of the L2-L3 disc group, in T12, T13, L1, and L2 dorsal root ganglions of the L3-L4 disc group, and in T12, T13, L1, and L2 dorsal root ganglions of the L4-L5 disc group. CONCLUSION: The dorsal portion of the lumbar discs from L1-L2 to L4-L5 is multisegmentally innervated by the T11 through L5 dorsal root ganglions. Sensory fibers from the upper dorsal root ganglions innervate the dorsal portion of the discs via the paravertebral sympathetic trunks, although those from the lower dorsal root ganglions innervate via the sinuvertebral nerves. Furthermore, sensory nerve fibers enter the paravertebral sympathetic trunks through the corresponding ramus communicans and reach the dorsal root ganglions via each ramus communicans at the L2 and/or more cranial levels.

Pressure distribution in the humeroradial joint and force transmission to the capitellum during rotation of the forearm: effects of the Sauvé-Kapandji procedure and incision of the interosseous membrane.

A biomechanical study was undertaken, using four fresh cadaveric arms, to evaluate the changes in pressure distribution in the humeroradial joint (H-R joint) during rotation of the forearm before and after the Sauvé-Kapandji procedure (S-K procedure) and also after incision of the interosseous membrane (IOM) following the S-K procedure. The pressure distribution was measured with a pressure-sensitive conductive rubber sensor while the forearm was rotated. Force transmitted to the capitellum was calculated from the measured pressure. In the intact specimens, pressure was concentrated on the medial side of the capitellum in pronation and on the posterolateral side in supination. The pattern of change after the S-K procedure and that after incision of the IOM following the S-K procedure were almost the same as that in the intact forearm. Although the force transmitted to the capitellum increased after the S-K procedure, there were no significant differences between the forces before and after the S-K procedure. However, the force increased significantly after incision of the IOM following the S-K procedure when the forearm was supinated more than 35 degrees, and it was concentrated on the posterior side of the capitellum. The IOM seemed to have an important axial load-bearing function in the forearm position supinated more than 35 degrees. The S-K procedure in patients suffering from distal radioulnar joint disorders with IOM injury is likely to induce H-R joint osteoarthritis, so it should be avoided in these patients.

Loss of the SEDL gene product (Sedlin) causes X-linked spondyloepiphyseal dysplasia tarda: Identification of a molecular defect in a Japanese family.

A 23-year-old man was diagnosed as having X-linked spondyloepiphyseal dysplasia tarda (SEDT; MIM 313400) based on his disproportionately short trunk, short stature, characteristic radiological features of the spine (posterior hump, end plate sclerosis, and disc space narrowing) and the hips (short and thick femoral necks), and positive family history. This Japanese family was found to have an intragenic deletion flanking intron 2 and exon 3 of the SEDL gene that not only included the 5' untranslated region but also the coding sequence for the first methionine through the 25th alanine. This mutation was present in the proband and his unaffected mother (a heterozygote), but not in an unaffected sister and an unaffected uncle. The nature of the mutation predicted that the SEDL protein (Sedlin) was not produced in the proband, indicating that loss of Sedlin caused SEDT.

Effects of electrical stimulation of the sciatic nerve on background electromyography and static stretch reflex activity of the trunk muscles in rats: possible implications of neuronal mechanisms in the development of sciatic scoliosis.

STUDY DESIGN: The effects of electrical stimulation of the sciatic nerve on background electromyographic and static stretch reflex activity of the trunk muscles were studied. OBJECTIVES: To verify the hypotheses that sciatic scoliosis is induced reflexively by radiculopathic pain, and that scoliosis might be maintained by prolonged asymmetric alteration of the trunk muscle tonus caused by central sensitization of the spinal neurons that constitute the postural reflex pathways. SUMMARY OF BACKGROUND DATA: Sciatic scoliosis usually occurs with convexity to the side of the herniated disc. The neuronal mechanism of sciatic scoliosis has not been well clarified. Recently, prolonged alteration of motor function in the hindlimbs of animals caused by central sensitization has been reported. METHODS: In spinalized rats (transection of the spinal cord), the sciatic nerve was stimulated electrically as a conditioning stimulus. Muscle stretch elicited by bending of the lumbar spine was applied as a test stimulus. Background and stretch reflex activities of the bilateral oblique abdominal, psoas, and quadratus lumborum muscles were recorded. Rats in which MK-801, an N-methyl-d-aspartate antagonist, was preadministered also were used. RESULTS: The conditioning stimulus enhanced background electromyographic activity in bilateral oblique abdominal, contralateral psoas, and quadratus lumborum muscles. Furthermore, the conditioning stimulus induced prolonged facilitation and depression of stretch reflex activity of the contralateral psoas and quadratus lumborum, and ipsilateral psoas and quadratus lumborum muscles, respectively. Preadministration of MK-801 reduced these excitatory and inhibitory effects. CONCLUSION: It was found that the pattern of electromyographic activity of the trunk muscles evoked by sciatic nerve stimulation coincided with the typical direction of sciatic scoliosis in patients with lumbar disc herniation. It was supposed that the prolonged asymmetric alteration of the trunk muscle tonus was caused by central sensitization, and that central sensitization of spinal neurons may underlie the neuronal mechanism of sciatic scoliosis.

Sensory innervation of the cervical facet joints in rats.

STUDY DESIGN: With a retrograde neurotracing method with Fluoro-Gold (FG; Fluorochrome, Denver, CO), the level of dorsal root ganglions (DRGs) innervating the C1-C2, C3-C4, and C5-C6 facet joints and their pathways were investigated in rats. OBJECTIVES: To clarify the levels of DRGs and parasympathetic nodose ganglions innervating the cervical facet joints and to determine the pathways from the facet joint to DRGs. SUMMARY OF BACKGROUND DATA: Patients with cervical facet lesions and whiplash sometimes experience diffuse neck pain, headache, arm, and shoulder pain, but the pattern of sensory innervation of the facet joint is still unclear. METHODS: Sixty male Sprague-Dawley rats were used. Fluoro-gold crystals (FG) were applied into the C1-C2 (C1-C2 group), C3-C4 (C3-C4 group) and C5-C6 (C5-C6 group) facet joints, and numbers of the labeled neurons in DRGs from C1 to T5 and nodose ganglions were determined. To determine the sensory pathway, bilateral sympathectomy was performed. RESULTS: Neurons labeled with FG were present in the DRGs from C1 through C8 in the C1-C2 group, from C1 to T2 in the C3-C4 group, and from C3 to T3 in the C5-C6 group without sympathectomy. In the nodose ganglions, 17 FG-labeled neurons were present. The number of the labeled neurons after sympathectomy was not significantly different in the C1, C2, and C3 DRGs in the C1-C2 group, in the C3 and C4 DRGs in the C3-C4 group, and in the C5 and C6 DRGs in the C5-C6 group from that in the groups without sympathectomy. In contrast, the number of labeled neurons in the DRGs was significantly less at the other levels than that in the groups without sympathectomy (P < 0.01). CONCLUSION: Sensory nerve fibers of the cervical facet joint were derived from the C1-T3 DRGs. Some sensory nerves from the cervical facet joint entered the paravertebral sympathetic trunks and reached the DRGs at multisegmental levels. The present findings regarding the multisegmental innervation to the facet joint may be of importance in the treatment of facet joint syndrome.

[Pulmonary function tests and their clinical significances on outside of textbooks].

Pulmonary functions are classified two kinds of functions which are respiratory and non-respiratory. We explained new clinical significant results by looking at the usual respiratory pulmonary function tests and devices in this paper. We found two new indexes on uneveness of ventilation by analyzed compartments of forced expiratory curves(Tiffneu curves) and at improvement of CO single breathing method on diffusing capacity test. We found new index on bronchial anaphylaxis for bronchial asthma by time constant measured from forced expiratory curves, also. We found new index on ventilatory efficiency at developing the automatic respiratory resistance meter by the forced oscillation method of Du Bois, too.