Pain and orthopaedic and neurologic signs after lumbar discectomy: a 2-year followup

In a prospective study of 161 consecutive patients with lumbar discectomy, pain, lumbar mobility, and neurologic and root tension signs were followed up for at least 2 years. Sciatica and root tension signs decreased promptly after surgery and remained largely unchanged during followup, which was not the case for neurologic signs. Similarly, pain relief was not associated with neurologic signs but was associated with lumbar mobility and root tension signs. Patients without neurologic symptoms before surgery did not report more sciatica after 2 years than did those with positive neurologic signs before surgery. Positive crossed Lasegue sign and restricted lumbar mobility before surgery predicted better chances for postoperative pain relief. Patients with a ruptured anulus fibrosus at surgery had less sciatica and back pain after surgery than did patients with an intact anulus fibrosus.     

Effects of phencyclidine on acoustic startle and prepulse inhibition in neuronal nitric oxide synthase deficient mice.

Prepulse inhibition of acoustic startle is a behavioural response, which is used to estimate sensorimotor gating deficits in schizophrenia. Recent studies show that several behavioural effects of the psychotomimetic drug, phencyclidine (PCP), in rodents are blocked by nitric oxide synthase (NOS) inhibitors suggesting that NO plays an important role in the pharmacological effects of PCP. The present study was conducted to examine the effects of PCP on prepulse inhibition in neuronal NOS (nNOS) deficient mice. PCP treatment caused a significant and dose-related increase in prepulse inhibition in nNOS-/- mice whereas prepulse inhibition was not significantly affected in +/+ and +/- mice. Basal prepulse inhibition level did not differ significantly between the groups. Furthermore, PCP caused a dose-related decrease in startle response reactivity in +/+ mice but did not significantly affect this measure in +/- and -/- mice. Basal startle response level did not differ between +/+ and +/- but was significantly lower in -/- mice. It is concluded that nNOS plays a role in the NO-sensitive effects of PCP.     

TREATMENT OF NON-HEALING ULCERS OF THE LOWER EXTREMITY WITH FREE MUSCLE FLAPS: Case reports

The surgical management of ulcers in the lower extremity is traditionally conservative, and includes debridement and split thickness skin grafting. In the most intractable cases, however, this management is often not enough. In this report of three patients with non-healing ulcers of the lower extremity successfully treated with free muscle flaps, we advocate a more active surgical approach to the treatment of such conditions. This is also appropriate in patients for whom a microsurgical approach might not be considered because of advanced age, peripheral arterio-occlusive disease, or the presence of other risk factors.     

The Effect of Reading Interventions among Poor Readers at a Forensic Psychiatric Clinic

The aim of the present study was to investigate the effect of a short period, 15 sessions, of reading interventions in a sample of adult forensic psychiatric patients: 61 patients with decoding difficulties – 44 in the experimental group and 17 in the comparison group – with an average age of 31.6 participated. Of these, 36% were female, and 29% had an immigrant background. The participants carried out a battery of reading tests. The results in the experimental group showed a medium effect size (d = .36 to .76) on all reading tests between pre- and post-test. The comparison group, however, showed no gain at all between the test occasions. The results indicate that a proportionally low reading intervention effort produces improvement in reading. This study discusses the importance of including reading assessment and offering remediation in order to reach optimal future social adjustment for patients in forensic clinics.     

Morphometry in Digital Photographs: A Promising Technique for Assessing Patients with Cleft Lip and Palate

As digital photography is being increasingly used in clinical medicine, we devised a software program for `on screen' image analysis, which allows distance, angle, and area to be measured. In this study, 30 photos were evaluated by 10 observers, so 3000 observations were used to test the reproducibility of the measurements. The results showed excellent reproducibility within observer, between observers, and between photographs. The coefficient of variation (CV) ranged from 0 to 1.3% for distance, from 0.6 to 2.3% for angle, and from 1.5 to 7.7% for area. The system could be particularly useful for assessing patients with cleft lip and palate.     

Effect of experimental jaw muscle pain on EMG activity and bite force distribution at different level of clenching

Bite force at different levels of clenching and the corresponding electromyographic (EMG) activity in jaw‐closing muscles were recorded in 16 healthy women before, during and after painful stimulation of the left masseter muscle. Experimental pain was induced by infusion of 5·8% hypertonic saline (HS), and 0·9% isotonic saline (IS) was infused as a control. EMG activity was recorded bilaterally from the masseter and temporalis muscles, and static bite force was assessed by pressure‐sensitive films (Dental Pre‐scale) at 5, 50 and 100% of maximal voluntary contraction (MVC) during each session. Visual feedback was applied by showing EMG activity to help the subject perform clenching at 5, 50 and 100% MVC, respectively. EMG activity at 100% MVC in left and right masseter decreased significantly during painful HS infusion (1·7–44·6%; P < 0·05). EMG activity at 5% and 50% MVC was decreased during HS infusion in the painful masseter muscle (4·8–18·6%; P < 0·05); however, EMG activity in the other muscles increased significantly (18·5–128·3%; P < 0·05). There was a significant increase in bite force in the molar regions at 50% MVC during HS infusion and in the post‐infusion condition (P < 0·05). However, there were no significant differences in the distribution of forces at 100% MVC. In conclusion, experimental pain in the masseter muscle has an inhibitory effect on jaw muscle activity at maximal voluntary contraction, and compensatory mechanisms may influence the recruitment pattern at submaximal efforts.     

Effect of transcranial direct current stimulation on neuroplasticity in corticomotor pathways of the tongue muscles

The aim of this study is to investigate effects of transcranial direct current stimulation (tDCS) on neuroplasticity in corticomotor pathways related to tongue muscles evoked by a training task using the tongue drive system (TDS). Using a crossover design, 13 healthy participants completed two sessions of tDCS while performing 30 min of TDS training. Sessions were spaced at least 2 weeks apart and participants randomly received anodal and sham tDCS stimulation in the first session and the other condition in the second session. Single and paired pulse transcranial magnetic stimulation was used to elicit motor evoked potentials (MEPs) of the tongue at three time‐points: before, immediately after and 30 min after training. Participant‐based reports of fun, pain, fatigue and motivation, level of difficulty and effort were evaluated on numerical rating scales. There was no consistent significant effect of anodal and sham stimulation on single or paired pulse stimulation MEP amplitude immediately or 30 min after TDS training. Irrespective of tDCS type, training with TDS induced cortical plasticity in terms of increased MEP amplitudes for higher stimulus intensities after 30 min compared with before and immediately after training. Participant‐based reports revealed no significant difference between tDCS conditions for level of fun, fatigue, motivation, difficulty and level of effort but a significant increase in pain in the anodal condition, although pain level was low for both conditions. In conclusion, tongue MEP amplitudes appear to be sensitive to training with the tongue using TDS; however, anodal tDCS does not have an impact on training‐evoked neuroplasticity of tongue corticomotor pathways.