Mathew Lee

Sympathetic vasomotor changes induced by manual and electrical acupuncture of the Hoku point visualized by thermography.

&NA; Considerable evidence implicates sympathetic neural activity in acupuncture analgesia. However, the exact nature of these effects has not been specified in detail, and many experimental findings are contradictory. This study evaluated in normal conditions the specific sympathetic effects of both manual and electrical acupuncture applied to the same hand (Hoku) point. Thermographie measures of superficial skin temperature were used to assess sympathetic vasomotor tone in the face, hand and foot of 19 normal subjects. Baseline assessment, manual acupuncture and electrical acupuncture were performed in 3 separate sessions in a well controlled, 23°C environment. Superficial skin temperature decreased slowly in the control condition. Both manual and electrical acupuncture produced a generalized long‐lasting warming effect, indicating reduced sympathetic activity (sympatholytic effect). In addition, electrical acupuncture induced a localized short‐term cooling effect, indicating a transient segmental increase in sympathetic activity (sympathomimetic effect).

Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point: Comparison with the Hoku hand point sympathetic effects

Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point were evaluated by thermography in 19 normal subjects under the same procedure used in a previous study using the Hoku hand point. A generalized long-lasting warming (sympathetic inhibition) effect was observed under manual and electrical acupuncture of the Tsusanli point. In addition, a segmentally related short-lasting cooling (sympathetic activation) effect occurred with Tsusanli electrical acupuncture only. The warming effect is consistent with the results of the Hoku study and appears to be a central sympathetic inhibition evoked by acupuncture. The cooling effect was segmentally related to the acupuncture site in both studies. This cooling effect most likely reflects a segmental activation of vasomotor spinal reflexes and not a general emotional arousal. These sympathetic mechanisms may be functionally correlated with central and peripheral mechanisms of acupuncture analgesia.

Workload and energy expenditure during wheelchair propelling

In this investigation it was tried to evaluate the workload of wheelchair driving in physical units, i.e. watts or meter kg./sec. For this reason an ergometer was adapted so that subjects sitting in wheelchairs with fixed brakes, could hand frank it. They were asked to perform at a standard workload of ½ watt/kg. body weight and at 1 watt/kg. body weight for 5 minutes each. During this time heart rate, CO2 elimination, O2 uptake, minute volume of respiration and the RQ were continuously recorded or calculated. In a second procedure these subjects were asked to drive a conventional wheelchair 5 to 6 minutes at a convenient speed. During the last 2 minutes the V was measured with the Korfryani-Müller spirometer and samples of expired air were taken for O2 and CO2 analysis. The heart rate was recorded by telemetry. In a third procedure the subjects drove their wheelchairs for 5 minutes on platforms equipped with rollers so that the above mentioned parameters could be measured continuously. The data collected in the second and third parts of the experiment were projected on the graph of performance of ergometric experiments, and plotted along the X-axis to estimate the workload in watts. By this method it was possible to calculate the physical workload of wheelchair driving within a range of approximately ±5 watts.

Hyperhidrosis--a case history.

The authors present a case report on hyperhidrosis. The social and occupa tional consequences of this disease entity are discussed as well as the genetic implications of this disorder. The medical and surgical treatments of hyperhidrosis are evaluated. The use of infrared imaging techniques as a cost-effective, rapid, noninvasive procedure to diagnose this disorder is described.

Clinical and Research Observations on Acupuncture Analgesia and Thermography

The concept of acupuncture become popular among the American medical community and lay public as a potential therapeutic tool following the American rapprochement with the People’s Republic of China in 1972. They found this idea both exciting and vaguely unsettling to their accustomed ways of thinking.

A precision tooth-pulp stimulation technique for the assessment of pain threshold

Accurate and consistent pain threshold measurements for the tooth pulp can be achieved with careful preparation of a moisture-proof appliance and the use of a high-quality constant-current stimulator. Using an extant dental filling as the cathode, the usual problems associated with the control of the stimulation area and locus and, consequently, current density can be overcome. Repeated measurements showing less than ±5% variation over many months can be routinely achieved on the same individual. The technique has shown a high degree of sensitivity to common analgesic agents and is potentially useful for the investigation of variations in pain threshold over extended periods of time.

Convalescence Care for Seniors in Lower Manhattan: An Interdisciplinary Approach to Community Rehabilitation

Application of principles of rehabilitation medicine to community health is an area of great importance to the care of the elderly. New York City has a high percentage of Chinese immigrants. The complexity of age and cultural and communication difficulties require special attention, and an interdisciplinary approach is essential for success. The “Convalescence Care for Seniors of Lower Manhattan,” a program located at New York University Downtown Hospital, is able to reach out successfully to an underserved Chinese population in Lower Manhattan. Through educational workshops, health fairs, and physician referrals, patients were able to receive the benefit of a functional approach.

Poster 121: Computerized infrared imaging as a tool in monitoring the clinical response to acupuncture treatment in a patient with chronic abdominal pain: a case report.1

Abstract Setting: Tertiary care hospital. Patient: A 21-year-old woman with poorly controlled type 1 diabetes mellitus and chronic abdominal pain and who was dependent on opioids. Case Description: The patient presented with a 3-month history of abdominal pain. She also complained of weight loss and constant fatigue. Magnetic resonance imaging of her abdomen revealed hepatomegaly and a 4.5cm mass in the right lobe of her liver. Ultrasound of her abdomen revealed an echogenic liver with a solid mass in the right lobe and borderline splenomegaly. Computed tomography-guided liver biopsy revealed a benign tumor. The patient had become dependent on opioids for chronic abdominal pain. She received supportive psychotherapy for management of her pain and depression. She was also referred for acupuncture as an adjunct to her pain management program. Computerized infrared imaging (CII) was performed both before and after acupuncture treatment as a means of objectively assessing her response to acupuncture. Assessment/Results: Initial data from the CII revealed significant asymmetry (>1.0°C), with the right lower quadrant of the abdomen being significantly warmer than the corresponding area on the contralateral side. The patient subsequently underwent acupuncture treatment, which she reported improved the abdominal pain. Follow-up CII of her abdomen revealed no significant asymmetry. Discussion: Acupuncture treatment afforded pain relief for this patient with a benign hepatic tumor and chronic abdominal pain. CII, a simple, noninvasive test that detects cutaneous temperature patterns due to inflammation or sympathetic nervous system activity, objectively documented the patient’s response to acupuncture treatment. Conclusion: CII may be a useful tool in objectively monitoring the clinical response to acupuncture treatment in patients with chronic abdominal pain.

Poster 120: Use of computerized infrared imaging to confirm clinically suspected complex regional pain syndrome in patients with chronic pain: a case series.1

Abstract Objective: To evaluate the usefulness of computerized infrared imaging (CII) in the diagnosis of complex regional pain syndrome (CRPS) in chronic pain patients with a clinical suspicion of CRPS. Design: Case series. Setting: Tertiary care center. Participants: 4 patients with complaints of pain of >3 months in duration who were clinically suspected of having CRPS. Intervention: Each patient underwent CII, which is a sensitive and noninvasive test that objectively documents cutaneous temperature patterns as a reflection of the underlying physiologic state of the sympathetic nervous system. Pain fibers are closely associated with the sympathetic nervous system. Main Outcome Measures: Analysis of CII to assess the degree of asymmetry in cutaneous temperature by comparing 1 area of the body to its corresponding location on the contralateral body area. Significant asymmetry was considered to be greater than a 1.0°C. Results: In each patient, CII demonstrated significant asymmetry in cutaneous temperature of at least 1.64°C in a minimum of 1 symptomatic area. The referring physicians were able to use these results to make a definitive diagnosis of CRPS in these patients. Conclusions: These cases demonstrated that CII could be a valuable and objective tool in confirming the diagnosis of CRPS in patients with chronic pain who were clinically suspected of having CRPS.

The primary role of the Erb's point-axilla segment in median and ulnar motor nerve conduction determinations in alcoholic neuropathy

Motor nerve conduction velocity (MNCV) was explored in the Erbs point-axilla (N-A) nerve segment of median and ulnar nerves, bilaterally, in 10 patients with a history of prolonged heavy drinking but in whom no other predisposing factors to peripheral neuropathy were found. For comparison, MNCV was determined also in the axilla-elbow (A-E), elbow-wrist (E-W) nerve segments, as well as the motor terminal latency (MTL) of the same nerves. A total of 140 nerve segments were tested tested but only 133 results were obtained. Abnormal MNCV or MTL was found in 36 or 27% of all tested nerve segments. From the latter, 38.9% were in the N-A nerve segments. Of N-A nerve segments tested, reduction in MNCV was found in 46.7%. Our results are statistically significant.