Joseph Stratford

Ice massage and transcutaneous electrical stimulation: Comparison of treatment for low-back pain

&NA; It has recently been shown that ice massage of the web between the thumb and index finger produces significantly greater relief of dental pain than a placebo control procedure. These results indicate that ice massage may be comparable to transcutaneous electrical stimulation (TES) and acupuncture, and may be mediated by similar neural mechanisms. The purpose of this study was to examine the relative effectiveness of ice massage and TES for the relief of low‐back pain. Patients suffering chronic low‐back pain were treated with both ice massage and TES. The order of treatments was balanced, and changes in the intensity of pain were measured with the McGill Pain Questionnaire (MPQ). The results show that both methods are equally effective: based on the Pain Rating Index of the MPQ, 67–69% of patients obtained pain relief greater than 33% with each method. The results indicate that ice massage is an effective therapeutic tool, and appears to be more effective than TES for some patients. It may also serve as an additional sensory‐modulation method to alternate with TES to overcome adaptation effects. Evidence that cold signals are transmitted to the spinal cord exclusively by A‐delta fibers and not by C fibers suggests that ice massage provides a potential method for differentiating among the multiple feedback systems that mediate analgesia produced by different forms of intense sensory input.

Seizures following intracranial surgery: incidence in the first post-operative week.

Consecutive craniotomies (118) drawn from major hospitals, and performed for disorders other than epilepsy or acute trauma were reviewed. The final diagnosis included tumor (70), subdural hematoma (13), aneurysm (10), arteriovenous malformation (7), and miscellaneous lesions (18). Eighty-seven (73.7%) patients had not experienced seizures prior to neurosurgery, 11 of these (12.6%) had a seizure within the first week, in six the attack occurred within 24 hours, and of these three had further attacks. In contrast, of the 31 patients (26.3%) that had one or more seizures prior to operation, 11 patients (35.5%) had seizures within the first week. In ten patients seizures occurred within the first 24 hours and of these seven had one or more recurrences later in the week. Anticonvulsant drugs were administered to 72 patients before operation, including all those with a history of seizures, but loading doses were not utilized to ensure therapeutic levels. In patients with predisposing factors to postoperative seizures, anticonvulsant drugs should be administered before or immediately following craniotomy in adequate dosage to rapidly achieve and maintain effective plasma levels. Phenytoin, owing to its minimal sedative effects is the drug of choice. A loading dose of 18 milligrams per kilogram can be safely administered as an admixture to an intravenous infusion of 0.9% saline with careful monitoring of cardiopulmonary function.

Neck tongue syndrome: operative management.

A 53-year-old woman with assimilation of the atlas to the occiput presented with paraesthesiae in the right half of her tongue and ipsilateral neck pain aggravated by head turning. After being intermittent for several years, the symptoms eventually became persistent and increasingly incapacitating. At operation, the C2 spinal nerves were found to be compressed by protuberant atlanto-axial joints, particularly on the right side. The superficial parts of the resected C2 spinal nerves showed a loss of both myelinated and unmyelinated nerve fibres. After operation, the patient experienced partial relief of her symptoms.

Comparative autoradiographic distribution of calcium channel antagonist binding sites for 1,4-dihydropyridine and phenylalkylamine in rat, guinea pig and human brain

The in vitro autoradiographic distribution of calcium channel antagonist binding sites for 1,4-dihydropyridine and phenylalkylamine has been investigated in rat, guinea pig and human brain. 1,4-dihydropyridine ([3H] (+) PN200-110) and phenylalkylamine ([3H] (-) D-888) binding sites are identically distributed in the brain of the three mammalian species studied. High densities of calcium antagonist binding sites are present in brain areas enriched in synaptic contacts such as the hippocampus, cortex and striatum. Low to moderate densities of sites are found in other regions such as the thalamus, hypothalamus and brain stem. These data demonstrate the existence of specific calcium antagonist binding sites in mammalian brain including man. These sites are discretely distributed with highest concentrations present in the hippocampus and cortex. Moreover, the similar distribution of binding sites for [3H] (+) PN200-110 and [3H] (-) D-188 suggests that 1,4-dihydropyridine and phenylalkylamine bind to the same receptor site complex in mammalian brain.

Visual abnormalities with multiple trauma.

Abstract The diversity of pathogenetic mechanisms involved in posttraumatic visual impairment was reviewed in a study of the hospital records of 24 patients admitted with multiple injuries. Most major visual abnormalities occurred in young people (average age 33 years) who presented with a wide range of overall severity of injury (injury severity score 13–47) and involvement of the central nervous system (Glasgow coma scale 5–15). Bilateral or monocular blindness developed in 63% of patients. Seventy percent of the injuries involved the anterior visual pathways with damage to the optic nerve alone accounting for 35%. Fractures of the sphenoid bone, particularly of the body, accompanied optic nerve and chiasmal injuries and some cases of traumatic carotid-cavernous fistulas. Pathogenetic mechanisms varied according to the site of injury and included vitreous hemorrhage and optic atrophy secondary to raised intracranial pressure, retinal hypoxia from carotid-cavernous fistulas, shearing and compression injuries of the optic nerve, traumatic chiasmal syndrome, temporoparietal and occipital contusions, and transtentorial herniation with occipital infarction. Visual abnormalities varied in severity from moderately reduced visual acuity and diverse hemianopias and scotomas to blindness. The incidence of posttraumatic residual visual abnormalities is likely to increase in the wake of improved acute care of the traumatized victim.

Congenital cervical spinal stenosis a factor in myelopathy

SummaryTen patients are reported who had congenital stenosis of the cervical spinal canal associated with varying degrees of neurological deficit.

Bilateral hypoglossal nerve injury with occipital condylar fracture.

BACKGROUND A 20-year-old woman with a right occipital condylar fracture and bilateral hypoglossal nerve injury is presented. Only 17 cases of condylar fracture have been reported in the literature. METHODS The patient was evaluated with plain films, coronal and axial cut CT, and MRI. RESULTS MRI showed a severely distorted but otherwise normal medulla and a displaced condylar bone fragment. CONCLUSION Condylar fracture may cause twelfth nerve palsy by injuring the central or peripheral nerve.

A clinical assessment of carotid and vertebral artery injection of macroaggregates of radioiodinated albumin (MARIA) for brain scanning.

Macroaggregates of human serum albumin measuring 10 microns or more will be filtered out by the capillary bed of the anterior and middle cerebral arteries with a carotid injection, and by the capillary bed of the posterior cerebral artery, brain stem, and cerebellum with a vertebral artery injection. The distribution of these particles is presumably a reflection of regional arterial blood flow. If these aggregates are labeled with I131, the brain can be scanned and lesions which alter arterial perfusion can be detected within the limits of resolution of the apparatus. Our early experience with the injection of MARIA into the carotid and vertebral arteries for brain scanning was published previously (2, 3). This report is an assessment of the technic in 42 patients who received a total of 50 injections (Table I). The lesions studied are listed in Table II. Method and Material The macroaggregates averaged 15 microns in size, with a range of 5 to 30 microns. The specific activity was 25 microcuries I131 per ...

Combined Radiocontrast and Radionuclide Cerebral Angiography

An assessment of serial brain scans obtained at one-second intervals following a carotid injection of radiopertechne-tate was initiated to determine its value as a supplement to contrast cerebral angiography (1, 2). Twenty-five patients had the radiopertechnetate administered immediately following cerebral angiography through the same carotid puncture. The analysis of these cases forms the basis of this report. Method and Material The entire angiographic procedure was performed with the patient under general anesthesia. After the radiographic component of the examination was completed, the patient was positioned under the gamma-ray scintillation camera (Pho/ Gamma II, Nuclear-Chicago). Rapid sequence scans were first obtained in the lateral projection following a 10-millicurie radiopertechnetate (Na99mTc04) carotid injection. A frontal series was procured immediately afterward with an additional 10-millicurie injection. The Robot time-lapse camera was set to take serial 0.8-second exposures, and concomita...

Radioxenon Brain Scanning with the Gamma-Ray Scintillation Camera

Cerebral blood flow has been studied with Xe133 (2, 4) and Kr85 (3) by externally monitoring the rate of disappearance of the radionuclide from the brain after inhalation of the gas or after a carotid artery injection of the gas dissolved in saline. The desaturation curves obtained with Xe133 consist of two (4) or three (2) exponential components; a fast component of T½ one and a half minutes and a slow component of T½ ten minutes (4). These purportedly reflect the cortical and white matter blood flow, respectively. The relatively quick disappearance of the radionuclide precludes scanning by conventional rectilinear apparatus, but the gamma-ray scintillation camera (Pho/Gamma, Nuclear-Chicago) is capable of imaging the brain in as short a time as thirty seconds for the dose of Xe133 used. This feature permitted an investigation of Xe133 as a test agent for scanning. It was administered via the carotid artery and/or inhalation, and a comparison was made, when possible, with the brain scan obtained with mac...