Duration Of Paralysis Research Articles

Surgical Outcome of Drop Foot Caused by Degenerative Lumbar Diseases

A total of 46 patients undergoing lumbar spine surgery for degenerative lumbar disease and presenting with drop foot were included in this retrospective study. To determine which preoperative patients' symptoms were of statistical significance in their effect on surgical outcome. Drop foot is a neuromuscular condition that results in palsy of the ankle dorsiflexion and is a major problem in Japanese daily life. Few studies have described the effect of a surgical intervention on drop foot associated with degenerative lumbar disorders and the factors that affect the surgical outcome. The manual muscle test can be used to determine the muscular strength of the tibialis anterior. Drop foot is then defined as a score below 3 out of 5. Patient medical history, preoperative tibialis anterior strength, presence of leg pain, and duration of palsy were recorded and compared with surgical outcome. Of patients, 61% recovered from drop foot after surgery. Patients with a tibialis anterior score of 2-3- and those suffering from palsy for a shorter duration of time showed better surgical results. Cases without leg pain were also shown to be treated effectively with surgery. Palsy duration and preoperative strength were factors that most affected drop foot recovery following surgical intervention for spinal degeneration.

Salt wasting, hypotension, polydipsia, and hyponatremia and the level of spinal cord injury

Case control. To test the reported correlation of hypotension, polydipsia, and hyponatremia with higher levels of spinal cord injury (SCI). A Veterans Administration Hospital, USA. The records of men who were paralyzed owing to trauma at any spinal cord level with motor complete lesions (ASIA A or B) and who received an annual physical and laboratory examination were reviewed for age, duration of paralysis, level of paralysis, blood pressure (BP), serum sodium, and 24 h urinary volume, creatinine, and sodium. Creatinine clearance and fractional excretion of sodium (FcNa) were calculated. Spearman rank-order correlations (r (s)) were carried out. Patients were aged 25 to 88 years, median 56 years, paralyzed 2-61 years, median 26 years, with levels of paralysis ranging from C2 to L4, median T4, n=111. From lower to higher levels of paralysis FcNa increased (0.4-7.3%), mean BP diminished (132-66 mmHg), urine volume increased (600-5400 ml), and serum sodium was reduced (148-129 mEq/l) - r (s)=0.29, 0.49, -0.22, and 0.23, respectively. Increasing 24 h urinary volumes correlated with lower serum sodium concentrations but higher creatinine clearance, r (s)=-0.28, 0.24. Increasing 24 h urinary sodium improved creatinine clearance, r (s)=0.37. P-values ranged from <0.05 to <0.001. Higher levels of SCI correlate with reduced sodium conservation, hypotension, polydipsia, and hyponatremia. Greater water intake raises creatinine clearance but lowers serum sodium. Greater salt intake increases creatinine clearance.

Fracture threshold in the femur and tibia of people with spinal cord injury as determined by peripheral quantitative computed tomography

Eser P, Frotzler A, Zehnder Y, Denoth J. Fracture threshold in the femur and tibia of people with spinal cord injury as determined by peripheral quantitative computed tomography. ObjectiveTo determine bone traits of the femur and tibia with peripheral quantitative computed tomography (pQCT) that best distinguish between spinal cord injury (SCI) subjects with and without fractures. DesignCross-sectional study. SettingIn- and outpatient paraplegic center in Switzerland. ParticipantsNinety-nine motor complete SCI subjects (duration of paralysis, 2mo–49y), 21 of whom had sustained fractures of the femur or tibia. InterventionsNot applicable. Main outcome measuresSubjects with SCI were questioned about the occurrence, location, and approximate date of fractures to their lower extremities. Trabecular and cortical bone mineral density (BMD), as well as bone geometric properties of distal epiphyses and midshafts of the femur and tibia, were measured by pQCT. ResultsTrabecular BMD of the femur and tibia distal epiphyses was found to distinguish best subjects with fractures from those without. Fractures occurred in subjects with trabecular BMD of less than 114mg/cm3 and less than 72mg/cm3 for the femoral and tibial distal epiphysis, respectively (corresponding to 46% and 29% of mean values of an able-bodied reference group). Approximately 50% of the subjects with chronic SCI (defined as time postinjury >5y for femur data and >7y for tibia data) had trabecular BMD values above the fracture threshold in the femur and about one third above the fracture threshold in the tibia. ConclusionsBy using pQCT, it may be possible to identify subjects with SCI who are at risk of sustaining fractures of the femur and tibia through minor trauma.

Assessment of anthropometric, systemic, and lifestyle factors influencing bone status in the legs of spinal cord injured individuals.

The aim of the present study was to assess the influence of muscle spasms, systemic or lifestyle factors on bone mass and geometry of the femur and the tibia in people with long-standing spinal cord injury (SCI). Fifty-four motor complete SCI people with paralysis duration of between 5 and 50 years were included in the study. Spasticity was measured by means of the Ashworth scale. Distal epiphyses and mid shafts of the femur, tibia, and radius were measured by peripheral quantitative computed tomography. From the epiphyseal scans, trabecular and total bone mineral density (BMDtrab and BMDtot) were calculated, and from the shaft scans, cortical BMD (BMDcort), total and cortical cross-sectional area (CSAtot and CSAcort), and muscle cross-sectional areas (CSAmus) were determined. Personal characteristics, anthropometric, as well as life-style factors, were assessed by means of a questionnaire. A Spearman correlation matrix was produced with measured data. Correlation coefficients exceeding 0.3 were tested for significance by performing linear regression for parametric data and ANOVA for non-parametric data. Subjects with higher spasticity scores had significantly larger CSAmus in the upper and lower leg. Both spasticity and CSAmus were found to be significantly related to BMDtrab and BMDtot of the distal epiphysis of the femur and to CSAcort of the femoral shaft. In the lower leg, bone parameters of the tibia were found to be strongly related to corresponding bone parameters of the radius, which suggests a systemic origin. No significant relationships were found between bone parameters and any of the life-style factors. The extent of bone loss caused by disuse of the lower extremities in people with long-standing SCI is influenced by systemic factors. Additionally, spasticity has a positive effect on bone parameters of the femur.

Relationship between the duration of paralysis and bone structure: a pQCT study of spinal cord injured individuals

The aim of the present study was to describe bone loss of the separate compartments of trabecular and cortical bone, as well as changes in bone geometry of a large number of spinal cord injured (SCI) individuals. Eighty-nine motor complete spinal cord injured men (24 tetraplegics and 65 paraplegics) with a duration of paralysis of between 2 months and 50 years were included in the study. Distal epiphyses and midshafts of the femur, tibia, and radius were measured by peripheral quantitative computed tomography. The same measurements were performed in a reference group of 21 healthy able-bodied men of the same age range. In the femur and tibia, bone mass, total and trabecular bone mineral density (BMDtot and BMDtrab, respectively) of the epiphyses, as well as bone mass and cortical cross-sectional area of the diaphyses, showed an exponential decrease with time after injury in the spinal cord injured subjects. The decreasing bone parameters reached new steady states after 3–8 years, depending on the parameter. Bone mass loss in the epiphyses was approximately 50% in the femur and 60% in the tibia, while the shafts lost only approximately 35% in the femur and 25% in the tibia. In the epiphyses, bone mass was lost by reducing BMD, while in the shaft bone mass was lost by reducing cortical wall thickness, a process achieved by endosteal resorption advancing at a rate of about 0.25 mm/year within the first 5–7 years after injury. Except for a slight transient decrease in cortical BMD of the femoral and tibial shaft during the first 5 years after the spinal cord lesion, cortical BMD of the spinal cord injured subjects was found to be at reference values. Bone parameters of the radial epiphysis in paraplegic subjects showed no deficits compared to the reference group. Furthermore, a trend for an increased radial shaft diameter suggests periosteal apposition as a consequence of increased loading of the arms.

The airway.

The airway.

Otologic Facial Palsy: Etiology, Onset, and Symptom Duration

To estimate the occurrence of otogenic facial palsy, we performed a retrospective case record study of all patients hospitalized for otogenic facial palsy in the period 1989 to 1999 at Ullevål University Hospital, which is the only referral hospital for patients with otologic sequelae in Oslo. The facial palsy was a complication of acute otitis media in 10 patients (56%), of acute mastoiditis in 3 patients (17%), of secretory otitis media in 3 patients (17%), and of chronic otitis media in 2 patients (11%). In half of the patients, complete facial palsy was found at the time of diagnosis. Sixteen patients (89%) reported a gradual onset of the facial palsy. The mean duration of otologic symptoms before the onset of facial palsy was 3 days (range, 1 to 9 days), and the median time to remission was 9 weeks (range, 2 to 96 weeks). Total remission was achieved in all patients who received follow-up. Although most patients recover within a few weeks, some patients have long-lasting facial palsy. Multicenter studies are needed to increase the sample size and to identify predictors of facial palsy duration.

Screening Patients with Prolonged Neuromuscular Blockade After Succinylcholine and Mivacurium

Patients with pseudocholinesterase (BChE) variants may exhibit markedly prolonged paralysis after the administration of succinylcholine or mivacurium. We sought to evaluate to what extent molecular biology may contribute to the biological assessment of such patients. We conducted a prospective cohort study in patients referred to our center between 1995 and 1999 for prolonged neuromuscular blockade after mivacurium or succinylcholine. For each patient, phenotyping was performed with a conventional biochemical technique and molecular biology for the detection of the atypical mutation (A variant). Among the 36 patients referred, 31 had low BChE activity, 26 had received mivacurium (BChE activity, 2.1 U/mL; 0.3–4.3 U/mL), and 5 had received succinylcholine (BChE activity, 1.9 U/mL; 1.1–3.2 U/mL) (mean; extreme values). The mean clinical duration of paralysis was 90 min (40–140 min) after succinylcholine and 301 min (120–720 min) after mivacurium. Thirty-two patients had a BChE deficiency of genetic origin: 20 were homozygous (AA), 10 were heterozygous (UA) for the A variant, and 2 did not have the A mutation (UU). One heterozygous UA patient had normal BChE activity. Nine among the heterozygous UA and the two homozygous UU patients probably carried a not-screened variant. In most cases, biochemical diagnosis was sufficient to confirm the existence of constitutional deficiency; molecular biology improved the accuracy of diagnosis in 11 patients (30%) but had few or no clinical implications for the patient him- or herself.

Screening Patients with Prolonged Neuromuscular Blockade After Succinylcholine and Mivacurium

Patients with pseudocholinesterase (BChE) variants may exhibit markedly prolonged paralysis after the administration of succinylcholine or mivacurium. We sought to evaluate to what extent molecular biology may contribute to the biological assessment of such patients. We conducted a prospective cohort study in patients referred to our center between 1995 and 1999 for prolonged neuromuscular blockade after mivacurium or succinylcholine. For each patient, phenotyping was performed with a conventional biochemical technique and molecular biology for the detection of the atypical mutation (A variant). Among the 36 patients referred, 31 had low BChE activity, 26 had received mivacurium (BChE activity, 2.1 U/mL; 0.3-4.3 U/mL), and 5 had received succinylcholine (BChE activity, 1.9 U/mL; 1.1-3.2 U/mL) (mean; extreme values). The mean clinical duration of paralysis was 90 min (40-140 min) after succinylcholine and 301 min (120-720 min) after mivacurium. Thirty-two patients had a BChE deficiency of genetic origin: 20 were homozygous (AA), 10 were heterozygous (UA) for the A variant, and 2 did not have the A mutation (UU). One heterozygous UA patient had normal BChE activity. Nine among the heterozygous UA and the two homozygous UU patients probably carried a not-screened variant. In most cases, biochemical diagnosis was sufficient to confirm the existence of constitutional deficiency; molecular biology improved the accuracy of diagnosis in 11 patients (30%) but had few or no clinical implications for the patient him- or herself. Systematic screening for the pseudocholinesterase atypical variant by biochemical and DNA analysis after a prolonged neuromuscular blocking effect of succinylcholine or mivacurium shows that molecular biology could improve the diagnosis in approximately one third of patients, but with few clinical implications, compared with biochemical testing.

Ischemic ophthalmoplegia in diabetic mellitus

Purpose : To analyze the natural course of ischemic diabetic palsies of the 3 rd , 4 th , and 6 th cranial nerves and their correlations with the status of diabetic control and retinopathy. Materials and methods : Twenty-nine patients with diabetic ophthalmoplegia, treated in Kaohsiung Medical University Hospital during the period 1996-1999, were included in the study. Data on clinical characteristics of the patients were obtained by chart review and the natural course of the cranial nerve palsies was analyzed. Laboratory studies, neuroimaging, and fundus studies were also performed. Results : Thirty-six episodes of ischemic ophthalmoplegia were recorded in 29 patients. Seventeen episodes of ophthalmoplgia occurred in patients with poor diabetic status. Third cranial nerve involvement occurred in 21 episodes, six of which (28.6%) had pupil involvement. Four patients had 4 th cranial nerve palsy and 11 episodes in nine patients involved 6 th cranial nerve palsy. Four patients had recurrent or alternate cranial nerve involvement, and three had simultaneous multiple cranial nerve involvement.The mean duration of paralysis was 2.8 ± 1.5 months with a significant difference ( p = 0.009) between the complete and incomplete palsy groups. Most of the cases had either no diabetic retinopathy ( No-DR )(55.2%) or only background diabetic retinopathy ( BDR )(34.5%). Except for average age, no significant difference was found between No-DR , BDR , and proliferative diabetic retinopathy ( PDR ) groups with respect to the duration of the palsies and fasting blood sugar levels. Age was significantly higher in the less severe diabetic retinopathy group (especially in the No-DR group). Conclusion : Cranial neuropathy with ophthalmoplegia is benign and self-limited. The oculomotor nerve was the most frequently involved in our group. Recovery time was dependent on ophthalmoplegia severity.The status of diabetic retinopathy and blood sugar level was not significantly related to the prognosis. Older diabetics (age > 63 years) had less severe retinopathy during attacks of ophthalmoplegia (p < 0.05). There might also be other risk factors, such as arteriosclerosis, inflammation, or anatomic variation, intervening in the pathogenesis of diabetic ophthalmoplegia.

The Role of the Synaptic Protein SNAP-25 in the Potency of Botulinum Neurotoxin Type A

Botulinum neurotoxin serotype A (BoNT/A) is distinguished from BoNT/E by longer duration of paralysis and greater potency. The proteolytic activity of BoNT/A in cultures of dissociated spinal cord neurons persists beyond 80 days, whereas BoNT/E activity persists for less than 1 day (Keller, J. E., Neale, E. A. Oyler, G., and Adler, M. (1999) FEBS Lett. 456, 137-142). This single quality of toxin activity can account for the differences observed in the duration of muscle block. In the present work we sought to understand the basis for the apparent greater potency of BoNT/A. BoNT/E cleaves a 26-amino acid fragment from the C terminus of the synaptic protein SNAP-25 whereas BoNT/A removes only nine residues creating a 197-amino acid fragment (P197) that is 95% the length of SNAP-25. We show that inhibition of neurotransmitter release by BoNT/E is equivalent to the damage caused to SNAP-25. However, synaptic blockade by BoNT/A is greater than the extent of SNAP-25 proteolysis. These findings can be explained if P197 produces an inhibitory effect on neurotransmitter release. A mathematical model of the experimentally determined relationship between SNAP-25 damage and blockade of neurotransmission supports this interpretation. Furthermore, neurotransmitter release following complete cleavage of SNAP-25 can be achieved by P197, but with about 5-fold less sensitivity to external Ca(2+). In this case, vesicular release is restored by increasing intracellular Ca(2+). These data demonstrate that P197 competes with intact SNAP-25, but is unable to initiate normal synaptic vesicle fusion in physiological concentrations of Ca(2+).

Neuromuscular paralysis as a pharmacodynamic probe to assess organ function during liver transplantation

Potential for assessing liver function during liver transplantation surgery by monitoring muscle paralysis from nondepolarizing neuromuscular blockers that are hepatically cleared is critically assessed. Rocuronium is strongly favored as a promising pharmacodynamic probe for predicting allograft liver function because it is predominantly eliminated via the liver and its putative metabolites are not active. Prolongation of recovery from rocuronium paralysis is closely correlated with allograft liver function postoperatively. Vecuronium, pancuronium, and perhaps pipecuronium may also prove to be useful probes, but the two former blockers have active metabolites. Further prospective studies are necessary with more precise measurement of neuromuscular function to confirm the predictive value of this method. Alterations in neuromuscular blocker plasma concentrations that are correlated with changes in liver function and either the dose required or the intensity or duration of paralysis needs to be demonstrated for this technique to be clinically useful.

Hospital readmissions in people with chronic spinal cord injury.

Longitudinal observational. To examine frequency and duration of hospital readmissions in a population based sample of people with chronic spinal cord injury (SCI) and to look at medical reasons necessitating readmissions and factors influencing them. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK and Regional Spinal Injuries Centre, District General Hospital, Southport, UK. One-hundred-and-ninety-eight SCI patients, all injured more than 20 years ago, were interviewed on three occasions and their medical records reviewed for the period 1990 - 1996. Between 1990 and 1996, 127 patients (64% of the sample) required hospital treatment for late medical complications, with 481 readmissions between them and the mean length of stay of 12.03 days per readmission. Only 58% of all readmissions were into specialised spinal injuries centres. Averaged over the entire sample, the readmission rate was 0.4 readmissions per person at risk per year, and the occupancy rate was 4.9 bed-days per person at risk per year. The most frequent reason for readmissions were urinary tract complications (40.5% of all readmissions) and the highest bed occupancy was for skin problems (32.2% of all bed-days). When compared with the non-hospitalised group (36% of the sample), the readmitted patients had longer duration of paralysis and lower disability and handicap scores as measured by Functional Independence Measure (FIM) and Craig Handicap Assessment & Reporting Technique (CHART). The subgroups did not differ significantly by neurological grouping or age. Urinary and skin complications are the two main reasons for hospital readmissions in people with chronic SCI. Risk of readmissions increases with time since injury and with disability and handicap severity. Hospital bed requirements for people with chronic SCI are greater than the amount of clinical provision currently available in specialised spinal centres. In order to meet the needs of the growing SCI population, more specialised spinal injuries care beds will be needed. Spinal Cord (2000) 38, 371 - 377.

RETRACTED: Abnormal bone and calcium metabolism in patients after stroke

To review how mineral stores and endocrine factors affect bone mass in poststroke patients immobilized by hemiparesis. Computer databases and published indexes. Case-control studies of hemiparetic poststroke patients examined regarding bone metabolism. References were obtained from MEDLINE; all data concerning the objective were used. Bone loss occurs in affected extremities after stroke. Immobilization from hemiplegia causes hypercalcemia. Insufficiency or deficiency of 25-hydroxyvitamin D (25-OHD) is very common in stroke patients and may be caused by poor dietary intake, decreased sunlight exposure, or both. Compensatory hyperparathyroidism may not occur because hypercalcemia inhibits the parathyroid glands even when 25-OHD is in the insufficient range. However, hyperparathyroidism does occur when 25-OHD is in the deficient range, in which case the parathyroid response to hypovitaminosis D overrides effects of hypercalcemia. Increased bone resorption was observed during the first year after stroke, declining to normal during the second year. During the first year, determinants of bone mineral density (BMD) in hands affected by hemiplegia were age, severity of hemiplegia, duration of paralysis, serum calcium concentration, and 25-OHD concentration. In the second year, BMD determinants on the hemiplegic side were severity of hemiplegia and 25-OHD concentration, whereas 25-OHD concentration was the only BMD determinant on the intact side. Administering 1alpha-hydroxyvitamin D3, vitamin K2, or ipriflavone ameliorated osteopenia on both sides and decreased the frequency of hip fracture on the hemiplegic side. Bone remodeling and determinants of bone mass for the affected and unaffected sides after stroke differ between the first and subsequent years.

The effect of childhood spinal cord injury on skeletal development: a retrospective study.

Cross-sectional clinical review. To assess the relationship between late spinal deformity in childhood onset spinal cord injury (SCI) and level of spinal cord lesion, severity of lesion, age at onset, duration of paralysis and pelvic deformities. People with spinal cord injury (onset in childhood) treated and followed up at the National Spinal Injuries Center (identified from case notes review, contacted and agreed to participate). One hundred and eighty-nine subjects satisfying study inclusion criteria (acute onset SCI before the 16th birthday) were identified by case note review of 8200 records. Eighty formed the group attending for clinical review including whole spine radiographs (AP and lateral). Clinical examination included neurological status and joint range of movements. Demographic data was recorded. Scoliosis occurred more frequently and was more severe in those injured at a younger age, 38 degrees, compared with 24 degrees in those injured later (P<0.05), in paraplegia, 33 degrees, versus tetraplegia, 17 degrees, (P<0.01) and in complete, 36 degrees, versus incomplete lesions, 18 degrees, (P<0.001). Lordosis angulation in paraplegic subjects was significantly greater than in tetraplegic subjects in both seated, 50 degrees versus 25 degrees (P<0.014) and standing subjects 78 degrees versus 59 degrees (P<0.017) respectively and for kyphosis in standing subjects, 52 degrees versus 31 degrees (P<0.01). Sagittal measurements were influenced by habitual posture (which also corresponded to the severity of the lesion). Younger age at onset was shown to be associated with more severe scoliosis, as has been reported by others. Subjects with paraplegia and complete lesions demonstrated a greater and more frequently occurring scoliosis than those with tetraplegia and incomplete lesions respectively. Lordosis was greater in those with paraplegia than with tetraplegia and in those with very incomplete lesions compared with complete lesions. However the influence of the severity of the lesion cannot be separated from the postural position when analyzing spinal deformity.

MUSCULAR DYSBALANCES IN DIFFERENT SHOULDER EXERCISES

229 Functionally, the shoulder is considered a ball joint, whereby high mobility is attended by low stability. Therefore, muscular balance is decisive for stability. Altered strength ratios are frequently described as "muscular dysbalances" and considered one of the causes of various shoulder pathologies, whereby objective quantification is difficult. In order to define muscular balance first, the strength ratios of reciprocal muscle groups (quotient of peak torque) for extension/flexion (EX/FL), abduction/adduction (AB/AD) and rotation movements (ERO/IRO) were determined in 166 untrained men (UM) and 83 untrained women (UF). Determination was made isometric, concentric (60°/s, 180°/s) and eccentric (60°/s, 120°/s, LIDO-Active). The influence on this norm of one-sided (25 high-performance tennis players, TPH; 18 leisure tennis players, TPL) and two-sided (32 gymnasts, GY) athletic exercise, altered daily exercise (11 paraplegics with paralysis time < 4 mo., PP; 11 Paraplegics with paralysis time > 2 years, PU) and a combination of longer existing, altered daily exercise and increased athletic exercise (16 trained paraplegics, PT) was examined (ANOVA, α=0.05). The definition of the sex-specific norm showed no differences in reciprocal strength ratios between UM and UF (p>0.05) in spite of different absolute torque values (p<0.05). EX, AD and ERO showed higher torques, so that the quotients were < 1. Morcover, there was a decrease in the sequence AB/AD > FL/EX > ERO/IRO. Shoulder stress in sports led to a decrease in quotients compared to UM due to a relatively increased maximum strength in EX, AD and ERO (p<0.01). At the beginning of a paraplegia (PP), the quotient of FL/EX and AB/AD is elevated (p<0.05). This altered ratio decreases with increasing duration of paralysis (PU). The combination of paraplegia and athletic exercise (PT) showed no difference in ratios to UM. With increased shoulder stress, the altered strength ratios reflect specific requirements of the performance attained. However, the importance of muscular dysbalances for the onset of shoulder complaints must be considered more important than their influence on athletic performance capacity.

Biomedical aspects of Botulinum Toxin

Clostridium botulinum produces a potent neurotoxin, which causes the neuroparalytic illness in humans and animals known as botulism. Seven immunologically distinct neurotoxins are recognized, which are designated by the letters A through G. the different serotypes of botulinum toxin vary in the animal species that they affect and the severity and duration of paralysis that they evoke. Botulinum toxin type A has become an important pharmaceutical for the treatment of segmental movement disorders, spasticity, pain syndromes, and various other neuronal disorders. Botulinum toxin specifically and tightly binds to cholinergic neurons. Upon endocytosis and internalization into the nerve terminal, the toxin acts to block or slow the exocytotic release of neurotransmitters, particularly acetylcholine. Selective injection of botulinum toxin into neuromuscular regions produces a local weakening of proximal muscles and relief from excessive involuntary muscle contractions In addition to directly affecting cholinergi...

Zoxazolamine-induced paralysis in two rat substrains: differences in hepatic drug metabolism.

Aldehyde dehydrogenase (ALDH) is involved in the metabolism of endogenous and exogenous aldehydes originating from biogenic amines, lipids, food and drugs. Rat liver contains at least two cytosolic ALDHs that can be stimulated by inducers of drug metabolism. Phenobarbital- type inducers increase ALDH1 activity while polycyclic aromatic hydrocarbons (such as benzo[alpha]pyrene) and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) increase ALDH3c isoenzyme activity. Two rat substrains were isolated according to a different induction of hepatic ALDH after treatment with phenobarbital (PB). Animals that responded to treatment (RR) and those that did not respond (rr) were inbred and divided into two homogenous groups. These animals constituted an ideal experimental model due to their common origin. Apart from the dramatic induction of cytosolic ALDH1 and ALDH3c, the effects of PB on pentoxy-, ethoxy- and methoxy-resorufin-O-dealkylase (P-, E-, and MROD) between the two substrains were also studied. 3-Methylcholanthrene (3MC) greatly increased ALDH3c levels in both substrains, although it was slightly more pronounced in the rr rats, in which it was assessed either as ALDH3c or as total cytosolic ALDH. A similar trend was also noted in EROD, PROD and MROD activities. Dealkylation of the methoxy group was found to be statistically different between the two substrains (rr > RR). The relevance of the biochemical findings with the in vivo hepatic capacity for drug metabolism was investigated by measuring the duration of zoxazolamine paralysis. Both animal substrains were tested with zoxazolamine either without pretreatment or after administration of PB or 3MC: the paralysis produced by zoxazolamine lasted for a longer period in rr than in RR rats. After pretreatment with PB, the duration of paralysis was greatly reduced, but the differences between the two substrains remained. Pretreatment with various doses of 3MC produced differences in the duration of paralysis in RR and rr rats, although the time period was much shorter than that observed in control animals.

Markedly Prolonged Paralysis After Mivacurium in a Patient Apparently Heterozygous for the Atypical and Usual Pseudocholinesterase Alleles by Conventional Biochemical Testing

Markedly Prolonged Paralysis After Mivacurium in a Patient Apparently Heterozygous for the Atypical and Usual Pseudocholinesterase Alleles by Conventional Biochemical Testing

Fractures After Myelopathy: The Risk Quantified

Fractures of the lower extremities have been recognized as a complication of paralysis with myelopathy due to spinal cord injury and impairment (SCI), but the risk has not been quantified and the effect of age, a correlate of predisposing osteoporosis, has not been documented. A long term follow-up review of patients with SCI was conducted to answer these questions. One hundred twenty male SCI patients (91 percent traumatic) were reviewed; the duration of paralysis at follow-up was 21.1 ± 12.1 years. Forty patients (33 percent) had sustained 76 fracture events resulting in 103 fractures (82 percent in the long bones of the lower extremities). The incidence of fracture events was directly related to age (14.5, 31.1 and 45.7 events per 1000 patient years for age intervals of 20 to 39, 40 to 59 and 60 to 79 years, respectively). Incidence rates for femoral (including hip) fracture in SCI patients were greater than those for the general population of men by factors of 104 and 24 at ages 50 and 70, respectively. In conclusion, the risk of fracture of lower extremity long bones in men is markedly increased by myelopathy and is raised further with aging. (J Spinal Cord Med 1997; 20:66-69)