Effects of postural changes of the upper limb on reflex transmission in the lower limb. Cervicolumbar reflex interactions in man

The influence of passive changes in upper limb position on the excitability of three myotatic arc reflexes (soleus, quadriceps, and biceps femoris) of the lower limb has been explored on 42 volunteers. The results indicate that the excitability of the three myotatic arcs can be influenced at a distance by postural modifications of the upper limb. When the ipsilateral upper limb is forwards or the contralateral backwards, a facilitation of both soleus and quadriceps tendon reflexes is observed while the biceps femoris reflexes are reduced. This pattern of facilitation and inhibition is reversed when the ipsilateral upper limb is backwards or the contralateral forwards. The facilitations as well as inhibitions of proximal myotatic arc reflexes are quantitatively more marked than that of the soleus reflex. Facilitation and inhibition are not linearly related to the angle of the arm with the trunk. Effects begin at a considerable angle, become maximal at 45 degrees, and progressively disappear for greater values. It is suggested that the distinct pattern of facilitation and inhibition which is exerted in reciprocal fashion on extensor and flexor motor nuclei might depend on the long propriospinal neurones connecting cervical and lumbar enlargements.     

Effect of spinal sympathetic blockade upon postural changes of blood flow in human peripheral tissues

The effect of head-up tilt upon subcutaneous and skeletal muscle blood flow in the crus was studied before and during epidural blockade in 10 subjects. Relative changes in blood flow were estimated by the local 133Xe washout technique. In subcutaneous tissue head-up tilt induced a decrease in blood flow of about 40% and there was no difference in the vascular response to head-up tilt before and during epidural blockade. In skeletal muscle tissue essentially the same was found as head-up tilt decreased blood flow by about 26% the response being uninfluenced by epidural blockade. In 3 patients local nervous blockade was induced by Lidocaine in 133Xe labelled subcutaneous tissue on one side. During epidural blockade and tilt blood flow increased by 12% whereas blood flow decreased by 30% on the control side. Thus epidural blockade had no influence on the vasoconstrictor response in subcutaneous tissue and skeletal muscle to head-up tilt whereas local blockade was able to prevent the response. Local mechanisms including the local veno-arteriolar reflex appear to play an important role for the observed maintenance of arterial blood pressure in the tilted position during central sympathetic blockade.     

Analysis of reflex changes in hepatic tissue blood flow elicited from the intestinal mucosa

The case of a 20-year-old female patient is which ileo-colic Crohn's disease developed after repeated attempts at contraceptive treatment (no rgestrel-ethinyl estradiol) had resulted in periods of diarrhea, which ceased after stopping treatment, is reported. As a consequence of the severity of the disease, after the 3rd attempt at using oral contraceptives (OCs) a partial removal of the ileum and colon had to be performed. The relation between Crohn's disease and other acute ulcerative colitis in patinets receiving OCs and the role of these drugs as a triggering factor in Crohn's disease are discussed. It is conclude d that, while their causative role is unproven, in view of studies on th e relation between pregnancy and this disease, OCs may favor the development of the disease, and intestinal disorders during OC treatment should be carefully monitored.     

Multivariate changes in coordination of postural control following spaceflight

BACKGROUND: Bright light therapy is the recommended treatment for winter seasonal affective disorder (SAD). However, the studies with the best placebo controls have not been able to demonstrate that light treatment has a benefit beyond its placebo effect. METHODS: Ninety-six patients with SAD completed the study. Patients were randomly assigned to 1 of 3 treatments for 4 weeks, each 1.5 hours per day: morning light (average start time about 6 AM), evening light (average start about 9 PM), or morning placebo (average start about 6 AM). The bright light (approximately 6000 lux) was produced by light boxes, and the placebos were sham negative-ion generators. Depression ratings using the Structured Interview Guide for the Hamilton Depression Rating Scale, SAD version (SIGH-SAD) were performed weekly. RESULTS: There were no differences among the 3 groups in expectation ratings or mean depression scores after 4 weeks of treatment. However, strict response criteria revealed statistically significant differences; after 3 weeks of treatment morning light produced more of the complete or almost complete remissions than placebo. By 1 criterion (24-item SIGH-SAD score <50% of baseline and < or =8), 61% of the patients responded to morning light, 50% to evening light, and 32% to placebo after 4 weeks of treatment. CONCLUSIONS: Bright light therapy had a specific antidepressant effect beyond its placebo effect, but it took at least 3 weeks for a significant effect to develop. The benefit of light over placebo was in producing more of the full remissions.     

Ciliospinal reflex in man

The revelation of secrets lies at the core of much psychotherapeutic method and was the seed from which early psychoanalytic theory grew. The notion of "the secret" can therefore be regarded as critical to an understanding of the psychotherapeutic process. This paper puts forward a view which contrasts, in important aspects, with traditional concepts and which emphasizes the positive or creative value of certain hidden ideas and the importance of the social arena on which they are displayed.     

Age-related changes in regional cerebral blood flow during working memory for faces

Young and old adults underwent positron emission tomography during the performance of a working memory task for faces (delayed match-to-sample), in which the delay between the sample and choice faces was varied from 1 to 21 s. Reaction time was slower and accuracy lower in the old group, but not markedly so. Values of regional cerebral blood flow (rCBF) were analyzed for sustained activity across delay conditions, as well as for changes as delay increased. Many brain regions showed similar activity during these tasks in both young and old adults, including left anterior prefrontal cortex, which had increased rCBF with delay, and ventral extrastriate cortex, which showed decreased rCBF with delay. However, old adults had less activation overall and less modulation of rCBF across delay in right ventrolateral prefrontal cortex than did the young adults. Old adults also showed greater rCBF activation in left dorsolateral prefrontal cortex across all WM delays and increased rCBF at short delays in left occipitoparietal cortex compared to young adults. Activity in many of these regions was differentially related to performance in that it was associated with decreasing response times in the young group and increasing response times in the older individuals. Thus despite the finding that performance on these memory tasks and associated activity in a number of brain areas are relatively preserved in old adults, differences elsewhere in the brain suggest that different strategies or cognitive processes are used by the elderly to maintain memory representations over short periods of time.     

Lower extremity blood flow and responses to occlusion ischemia differ in exercise-trained and sedentary tetraplegic persons

OBJECTIVE: To test whether lower extremity blood flow and hyperemic responses to vascular occlusion differ among electrically stimulated exercise trained and sedentary tetraplegic persons and subjects without tetraplegia (control). DESIGN: Blinded cross-sectional comparison, control group. SETTING: Academic medical center. PARTICIPANTS: Ten sedentary tetraplegic men, 10 tetraplegic persons previously habituated to electrically stimulated cycling exercise for 0.4 to 7 years, and 10 nondisabled controls. OUTCOME MEASURES: Subjects underwent quantitative Doppler ultrasound examination of the common femoral artery (CFA). End-diastolic arterial images and arterial flow-velocity profiles obtained at rest and following five minutes of suprasystolic thigh occlusion were computer digitized for analysis of heart rate (HR), CFA peak systolic velocity (PSV), CFA cross-sectional area (CSA), flow velocity integral (FVI), and computed CFA inflow volume (IV). RESULTS: No group main effects were observed for resting HR or FVI. At rest, trained tetraplegic men had 14.9% greater PSV, 29.8% larger CSA, and 51.3% greater IV (p values < .05) than sedentary tetraplegic subjects. Resting PSV and IV of the trained subjects did not differ from controls, although CSA was smaller than controls (p < .05). Following occlusion, PSV, CSA, and IV averaged 16.5%, 33.4%, and 65.1% greater for trained tetraplegics persons, respectively, than sedentary tetraplegic subjects (p values < .05). Only CSA differed between the control and the trained groups (p < .05). CONCLUSION: Tetraplegic persons conditioned by electrically stimulated cycling have greater lower extremity blood flow and hyperemic responses to occlusion than do their sedentary counterparts.     

Age-related ocular blood flow changes

PURPOSE: Pulsatile ocular blood flow (POBF is influenced by well-known parameters, such as intraocular pressure (IOP), heart rate, scleral rigidity, blood pressure, and posture. Age is also likely to influence POBF strongly. The purpose of this study was to evaluate POBF in relation to age in normal subjects. METHODS: Relevant data were collected from a sample of 105 normal subjects, ranging in age from 10 to 80 years. To measure the effect of age on POBF, the subjects were divided into seven groups of 15 subjects each; the age range of each group spanned one decade, beginning with age 10. POBF and pulse amplitude (PA) were measured in sitting and supine positions and after suction cup application. RESULTS: Using linear regression analysis, there was a significant correlation between PA and age in the supine position (P = 0.012) and after suction cup application (P = 0.002); in the sitting position, there was a borderline level of statistical significance (P = 0.053). In the sitting position, POBF was 819 +/- 212 microliters/minute in the second decade and 630 +/- 194 microliters/minute in the eighth decade. In the sitting position and after suction cup application, but not in the supine position, a statistically significant correlation between POBF decrease and age was found with linear regression analysis (P < 0.001 and P = 0.004, respectively). Using multiple regression analysis, POBF values revealed a significant correlation with age (P < 0.001), but not with systolic and diastolic brachial pressure. Considering all the subjects, analysis of variance for repeated measures highlighted a significant decrease of POBF from the sitting to the supine position and associated with an IOP increase (P < 0.001) without significant changes of PA. After suction cup application, there was a significant reduction of both PA and POBF (P < 0.001). CONCLUSIONS: The data revealed that as age increased, PA decreased in all three series of measurements. POBF decreased with age, and in subjects older than 50 years, the decrease was more evident. These findings are especially noticeable after IOP increase with suction cup. It must be considered that the age-related value of POBF is a fundamental parameter to evaluate correctly the hemodynamic aspects of the pathologies affecting the eye.     

Local nervous mechanism in regulation of blood flow in human subcutaneous tissue

The effect of local venous stasis upon blood flow in human subcutaneous adipose tissue on the distal part of the forearm was investigated in three healthy subjects and two chronically sympathectomized patients suffering from manual hyperhidrosis. The area under study was separated into two parts by means of a lead shield exerting a pressure of about 360 mmHg on the skin. The effect of venous stasis of about 40 mmHg on one side of the shield upon blood flow measured simultaneously on both sides of the shield by the local 133Xenon washout technique was investigated. During venous stasis on one side of the shield, blood flow decreased about 40% on both sides. The vasoconstrictor impulse could be transmitted over a distance of about 1-2 cm. The phenomenon was unaffected by nerve blockade induced 3 cm proximally, medially, and laterally to the area by infiltration the skin with lidocaine. Thus a vasoconstrictor impulse could be transmitted from the side of stasis to the non stasis side of the lead shield. The transmission was not affected by phentolamine but was blocked by lidocaine and chronic sympathetic denervation. The vasoconstrictor impulse elicited during venous stasis is therefore most likely transmitted by means of a local nervous mechanism involving sympathetic adrenergic vasoconstrictor fibres.     

Cerebral blood flow changes in cluster headache

Serial cerebral blood flow studies performed by the intra-carotid 133Xenon method were fortuitously determined during the course of a cluster headache in a 32 year old man. The initial study was performed about 10 min after the headache began and showed values at the upper limit of normal. Twenty min after the headache started a second procedure showed that the autoregulatory response on hyperventilation was normal. Ergotamine tartrate was given intra-muscularly 23 min after the headache began and there was partial relief. A third cerebral blood flow estimation showed abnormally high values. The probable reasons for this are discussed.     

Effects of droperidol-dopamine interaction on renal blood flow in man

A cystic swelling in the orbit due to Histoplasma duboisii, clinically thought to be a dermoid cyst, is described.     

Sympathetic reflex dystrophy: an uncommon illness in childhood]

We measured activities of dynorphin-converting enzyme (DCE), substance P endopeptidase (SPE) and angiotensin-converting enzyme (ACE) in cerebrospinal fluid (CSF) in 13 patients with rhizopathic pain from an herniated lumbar disc, in 9 patients with pain from coxarthrosis and in 11 control patients without pain. In the patients with disc hernia and coxarthrosis, another sample of CSF was analyzed 3-12 months after treatment, when pain had subsided. The DCE activity in the patients was higher than that in both the control patients and the patients with pain from coxarthrosis (nociceptive pain). Similarly, the activity of SPE was lower in the patients with herniated lumbar disc than in controls and in the patients with coxarthrosis. After treatment, the difference in activity compared to controls was lower, but still significant in patients with herniated discs. The ACE activity did not differ from controls in patients with ischialgia, while it was increased in patients with coxarthrosis. This increase also remained after arthroplasty with pain relief. In conclusion, measurements of neuropeptides may be useful for evaluating neuropathic pain.     

Neural control of cochlear blood flow

Effects of intraarterial and intravenous injections of autonomic nervous system agents on cochlear blood flow were studied in order to investigate the neural control of the inner ear vessels. Blood flow changes in the inner ear of the guinea pig were measured with an electrical impedance plethysmograph. Rather weak control of the vertebrobasilar and labyrinthine arteries by the sympathetic nervous system of the alpha-receptor type did appear to exist. Beta-receptors of the sympathetic nerve appeared to be non-existent in the cochlear vessels, and parasympathetic modulation was not evident.     

Static postural control in children

The purpose of this study was to investigate "static" balance characteristics in four and eight year old children performing six developmental tasks leading to upright stance. The data were evaluated with electromyographic, center of gravity and photographic procedures. The results of the study indicated that the older age group of children demonstrated higher degrees of motor control in all the balance tasks involving upper and/or lower extremity support of the trunk. The eight year old children showed less postural sway, more definitive muscular localizations and smaller degrees of motor activity occurring during the execution of the developmental tasks.     

Exhaled NO during graded changes in inhaled oxygen in man

BACKGROUND: Nitric oxide (NO) is present in the exhaled air of animals and humans. In isolated animal lungs the amount of exhaled NO is decreased during hypoxia. A study was undertaken to determine whether changes in arterial oxygen tension affect levels of exhaled NO in humans. METHODS: Sixteen healthy subjects were randomised to inhale different gas mixtures of oxygen and nitrogen in a double blind crossover study. Eight gas mixtures of oxygen and nitrogen (fractional inspired oxygen concentration (FiO2) 0.1 to 1.0) were administered. Exhaled NO was measured with a chemiluminescence detector from end expiratory single breath exhalation. RESULTS: A dose-dependent change in exhaled NO during graded oxygen breathing was observed (p = 0.0012). The mean (SE) exhaled NO concentration was 31 (3) ppb at baseline, 39 (4) ppb at an FiO2 of 1.0, and 26 (3) ppb at an FiO2 of 0.1. CONCLUSIONS: The NO concentration in exhaled air in healthy humans is dependent on oxygen tension. Hyperoxia increases the level of exhaled NO, which indicates increased NO production. The mechanism behind this phenomenon remains to be elucidated.     

Regional cerebral blood flow changes in chronic alcoholic patients induced by naltrexone challenge during detoxification

A follow-up study was performed with the aim to evaluate all individuals surgically treated by the uvulopalatopharyngoplasty (UPPP) or laser uvulopalatoplasty (LUPP) method from a whole county in Sweden, 1-8 years after surgery, by assessing snoring occurrence and daytime sleepiness, as experienced by the patients and their cohabitants. Questionnaires were mailed to all operated people (n = 457) and were returned by 91% (346 men, 69 women) preoperatively diagnosed as habitual snorers (n = 255), cases of obstructive sleep apnea syndrome (n = 110) and unspecified snorers (n = 48). In addition 345 bedpartners participated. For outcome of surgery, no significant differences in diagnoses or sex were found. Improvement in snoring occurrence was reported by 89.6% of the patients, confirmed by 92% of the cohabitants (r = 0.84, p < 0.01). The remaining snoring occurrence was significantly dependent on the surgical method and the time after operation. Excessive daytime sleepiness (EDS) was experienced by 73.3% of the patients compared to 67% reported by the cohabitants. Of 415 patients operated on, 18% were free from snoring and 25% were free from EDS. Individuals with a shorter time since surgery reported less snoring. The UPPP method gave a significantly better result than LUPP for the symptom 'snoring'.     

A cerebral blood flow study on tonic pain activation in man

The investigations of hair samples obtained from human skeleton from the Christian cemetery of Sayala demonstrate the presence of nicotine. 12 of 39 individual hair samples were positive. These results indicate the use of plants containing nicotine as principal or secondary alkaloid.     

Gaze stabilization by optokinetic reflex (OKR) and vestibulo-ocular reflex (VOR) during active head rotation in man

Vestibulo-ocular reflex (VOR)-optokinetic reflex (OKR) interaction was studied in normal human subjects during active sine-like head movements in the horizontal plane for a variety of vestibular-optokinetic stimulus combinations (frequency range, 0.05-1.6 Hz). At low to mid frequencies (< 0.2 Hz) the eyes tended to be stabilized on the optokinetic pattern, independently of whether the head, the pattern, or both were rotated. At higher frequencies, the OKR gain was attenuated and, in each of the differing stimulus combinations, the eyes became increasingly stabilized in space. Qualitatively similar results were obtained when, for the same visual-vestibular combinations, the head was passively rotated at 0.05 and 0.8 Hz. The data could be simulated by a model which assumes a linear interaction of vestibular and optokinetic signals. It considers the OKR with its negative feedback loop of primordial importance for image stabilization on the retina and the VOR only as a useful addition which compensates for the limited bandwidth of the OKR during high frequency/velocity head rotations in a stationary visual environment.     

Cerebral blood flow changes in acute experimental haemorrhagic vasospasm

Subarachnoid haemorrhage was produced in 26 dogs by injecting fresh homogenous blood into the cysterna chiasmatica. Two types of vasospasm were observed, firstly segmental arterial spasm closely related to the bleeding point and secondly generalized arterial vasospasm not directly related to the bleeding point and often occurring some way from the bleeding point. Reduction in CBF occurred in 61% of cases and was always accompanied by radiological vasospasm. However, in about one quarter of the cases with vasospasm there was no alteration in CBF.