Modulation of the rectoanal inhibitory reflex (RAIR): qualitative and quantitative evaluation in multiple sclerosis

BACKGROUND

Rectoanal inhibitory reflex (RAIR) is a physiological modulated reflex involved in anorectal continence and defined by a relaxation of internal anal sphincter following rectal distension. Its existence depends on intramural autonomic ganglions and its modulation on the integrity of the autonomic nervous system (ANS).

AIMS

The aim of this study was to analyse RAIR modulation in terms of amplitude and duration in multiple sclerosis (MS) patients.

METHODS

Twenty-one patients with MS and 40 control patients had anorectal manometry. Qualitative assessment (presence or absence) of RAIR was evaluated together with its modulation in amplitude and in duration.

RESULTS

All patients had present RAIR for each volume of rectal distension (10-50 ml). Seven patients (33.3%) in the MS group had abnormal RAIR modulation in amplitude (odds ratio (OR) = 2.78, compared to control group, p = 0.11). Nine patients (42.9%) in the MS group had abnormal RAIR modulation in duration (p = 0.14, OR = 2.54, compared to control group). Alteration of RAIR modulation was not correlated with Expanded Disability Status Scale, faecal incontinence and constipation (p > 0.05). Course of MS (relapsing-remitting MS or secondary progressive form) seems to be correlated to alteration of modulation in amplitude and in duration (OR = 1.31 and 1.07).

CONCLUSION

Even if our results do not have the required statistical significance (p > 0.05), they are interesting. If RAIR is always present in MS, its modulation seems to be altered. A hypothesis for this lack of RAIR modulation could be the alteration of ANS, often involved in MS besides somatic nervous system lesions.

An experimental study of artificial murine bladder reflex arc established by abdominal reflex

BACKGROUND

The neurogenic bladder dysfunction caused by spinal cord injury is difficult to treat clinically. The aim of this research was to establish an artificial bladder reflex arc in rats through abdominal reflex pathway above the level of spinal cord injury, reinnervate the neurogenic bladder and restore bladder micturition.

METHODS

The outcome was achieved by intradural microanastomosis of the right T13 ventral root to S2 ventral root with autogenous nerve grafting, leaving the right T13 dorsal root intact. Long-term function of the reflex arc was assessed from nerve electrophysiological data and intravesical pressure tests during 8 months postoperation. Horseradish peroxidase (HRP) tracing was performed to observe the effectiveness of the artificial reflex.

RESULTS

Single stimulus (3 mA, 0.3 ms pulses, 20 Hz, 5-second duration) on the right T13 dorsal root resulted in evoked action potentials, raised intravesical pressures and bladder smooth muscle, compound action potential recorded from the right vesical plexus before and after the spinal cord transaction injury between L5 and S4 segmental in 12 Sprague-Dawley rats. There were HRP labelled cells in T13 ventral horn on the experimental side and in the intermediolateral nucleus on both sides of the L6-S4 segments after HRP injection. There was no HRP labelled cell in T13 ventral horn on the control side.

CONCLUSION

Using the surviving somatic reflex above the level of spinal cord injury to reconstruct the bladder autonomous reflex arc by intradural microanastomosis of ventral root with a segment of autologous nerve grafting is practical in rats and may have clinical applications for humans.

Overexpression of NGF in mouse urothelium leads to neuronal hyperinnervation, pelvic sensitivity, and changes in urinary bladder function

NGF has been suggested to play a role in urinary bladder dysfunction by mediating inflammation, as well as morphological and functional changes, in sensory and sympathetic neurons innervating the urinary bladder. To further explore the role of NGF in bladder sensory function, we generated a transgenic mouse model of chronic NGF overexpression in the bladder using the urothelium-specific uroplakin II (UPII) promoter. NGF mRNA and protein were expressed at higher levels in the bladders of NGF-overexpressing (NGF-OE) transgenic mice compared with wild-type littermate controls from postnatal day 7 through 12-16 wk of age. Overexpression of NGF led to urinary bladder enlargement characterized by marked nerve fiber hyperplasia in the submucosa and detrusor smooth muscle and elevated numbers of tissue mast cells. There was a marked increase in the density of CGRP- and substance P-positive C-fiber sensory afferents, neurofilament 200-positive myelinated sensory afferents, and tyrosine hydroxylase-positive sympathetic nerve fibers in the suburothelial nerve plexus. CGRP-positive ganglia were also present in the urinary bladders of transgenic mice. Transgenic mice had reduced urinary bladder capacity and an increase in the number and amplitude of nonvoiding bladder contractions under baseline conditions in conscious open-voiding cystometry. These changes in urinary bladder function were further associated with an increased referred somatic pelvic hypersensitivity. Thus, chronic urothelial NGF overexpression in transgenic mice leads to neuronal proliferation, focal increases in urinary bladder mast cells, increased urinary bladder reflex activity, and pelvic hypersensitivity. NGF-overexpressing mice may, therefore, provide a useful transgenic model for exploring the role of NGF in urinary bladder dysfunction.

The role of transient receptor potential vanilloid 1 in mechanical and chemical visceral hyperalgesia following experimental colitis

The transient receptor potential vanilloid 1 receptor (TRPV1) is an important nociceptor involved in neurogenic inflammation. We aimed to examine the role of TRPV1 in experimental colitis and in the development of visceral hypersensitivity to mechanical and chemical stimulation. Male Sprague-Dawley rats received a single dose of trinitrobenzenesulfonic acid (TNBS) in the distal colon. In the preemptive group, rats received the TRPV1 receptor antagonist JYL1421 (10 mumol/kg, i.v.) or vehicle 15 min prior to TNBS followed by daily doses for 7 days. In the post-inflammation group, rats received JYL1421 daily for 7 days starting on day 7 following TNBS. The visceromotor response (VMR) to colorectal distension (CRD), intraluminal capsaicin, capsaicin vehicle (pH 6.7) or acidic saline (pH 5.0) was assessed in all groups and compared with controls and naïve rats. Colon inflammation was evaluated with H&E staining and myeloperoxidase (MPO) activity. TRPV1 immunoreactivity was assessed in the thoraco-lumbar (TL) and lumbo-sacral (LS) dorsal root ganglia (DRG) neurons. In the preemptive vehicle group, TNBS resulted in a significant increase in the VMR to CRD, intraluminal capsaicin and acidic saline compared the JYL1421-treated group (P<0.05). Absence of microscopic colitis and significantly reduced MPO activity was also evident compared with vehicle-treated rats (P<0.05). TRPV1 immunoreactivity in the TL (69.1+/-4.6%) and LS (66.4+/-4.2%) DRG in vehicle-treated rats was increased following TNBS but significantly lower in the preemptive JYL1421-treated group (28.6+/-3.9 and 32.3+/-2.3 respectively, P<0.05). JYL1421 in the post-inflammation group improved microscopic colitis and significantly decreased the VMR to CRD compared with vehicle (P<0.05, >/=30 mm Hg) but had no effect on the VMR to chemical stimulation. TRPV1 immunoreactivity in the TL and LS DRG was no different from vehicle or naïve controls. These results suggest an important role for TRPV1 channel in the development of inflammation and subsequent mechanical and chemical visceral hyperalgesia.

Influence of endometriosis on visceromotor and cardiovascular responses induced by vaginal distention in the rat

This study examined pseudoaffective responses elicited by vaginal distention in urethane-anesthetized rats, and tested hypotheses that responses would be increased by endometriosis (ENDO) and vary with the estrous cycle. Three groups were studied: ENDO, shamENDO, and Naive. ENDO was induced by autotransplanting small pieces of uterine horn (or, for shamENDO, fat) on mesenteric arteries. Ten weeks later, rats in proestrus or metestrus were anesthetized with urethane. Distendable latex balloons were inserted into the vaginal canal. While an increasing series of vaginal distentions was delivered, changes in electromyographic activity of the external oblique musculature (visceromotor response, VMR) and mean arterial pressure (pressor) responses were simultaneously measured. Vaginal distention produced VMR and pressor responses in all groups. These responses were significantly greater in ENDO than in the other groups, and greater in proestrus than metestrus. Although the overall amount of cystic tissue was greater in proestrous than metestrous rats, there was no correlation between these amounts and VMR or pressor responses. Acute spinalization (T8-T9) and bilateral pelvic, but not hypogastric, neurectomy attenuated both VMR and pressor responses, supporting the hypothesis that vaginal nociception involves suprathoracic spinal processing of information conveyed by the pelvic nerve. These effects on VMR and pressor responses to vaginal distention parallel behavioral escape responses to the same stimuli reported previously. The findings encourage continued use of VMR and pressor responses for further investigation of mechanisms underlying pain associated with ENDO and its potential treatment.

Ultrasound evaluation of dynamic responses of female pelvic floor muscles

Ultrasound imaging of the pelvic floor carries diagnostically important information about the dynamic response of the pelvic floor muscles (PFM) to potentially incontinence-producing stress, which cannot be readily captured and assimilated by the observer during the scanning process. We presented an approach based on motion tracking quantitatively to analyze the dynamic parameters of PFM on the ano-rectal angle (ARA). Perineal ultrasonography was performed on 22 asymptomatic females and nine stress urinary incontinent (SUI) patients with a broad age distribution and parity. The ventral-dorsal and cephalad-caudad movements of the ARA were resolved and kinematic parameters, in terms of displacement, trajectory, velocity and acceleration, were analyzed. The results revealed the possible mechanisms of PFM responses to prevent the urine from incontinence in fast and stress events such as coughs. The statistical analyses showed that the PFM responses of the healthy subjects and the SUI patients are significantly different in both the supine and standing experiments.

Functional consequences of motor unit recruitment order reversals following spinal cord transection in cat

Motoneuron recruitment order determinations were made for acute, 2-week chronic, and 3-month chronic spinal cats by comparing cutaneous nerve stimulation thresholds for evoking single unit tibialis anterior (TA) electromyogram (EMG) spikes of different sizes. Recruitment order was largely ( approximately 80%) orderly (small spikes recruited at lower stimulus intensities than large spikes) in acute and 3-month chronic spinal animals. However, in 2-week chronic spinal animals recruitment order was reversed, with large units more often recruited at lower stimulus intensities than small units ( approximately 65%). Morphological analyses of TA muscle fibers suggested that fiber size changes were unlikely to account for the dramatic alterations in recruitment order results of the 2-week chronic spinal animals. Additional studies suggested that the recruitment order reversal in the 2-week chronic animals coincided with an enhanced reflex neural output (increased recruitment or reflex gain) for the flexion reflex which compensated for disuse atrophy related decreases in flexor muscle force generation capability in these animals. The data from 2-week chronic spinal animals represent a functionally significant example of deviation from the normal size principle of motoneuron recruitment order as the corresponding reflex gain increases can enhance the rapidity of motor function recovery (standing, locomotion) following spinal injury.

Effects of acute and chronic restraint stress on visceral sensitivity and neuroendocrine hormones in rats

OBJECTIVE

To investigate the effects of acute and chronic partial restraint stress (PRS) on visceral sensitivity to colorectal distention and the neuroendocrine response in rats.

METHODS

Male Sprague-Dawley rats were used in this study. The abdominal withdrawal reflex score was assessed before stress, immediately after acute or chronic PRS, and 7 days after the first stress. The plasma levels of corticosterone (CORT) and adrenocorticotropic hormone (ACTH) were detected by radioimmunoassay at different time points.

RESULTS

The abdominal withdrawal reflex scores of the rats with acute or chronic PRS were significantly higher immediately after stress than those before and 7 days after the stress (P < 0.05). The levels of CORT (25.35 +/- 6.03 ng/mL) and ACTH (312.47 +/- 50.76 pg/mL) in rats with acute PRS showed a significant elevation immediately after stress compared to rats without PRS (7.24 +/- 2.97 ng/mL, 97.00 +/- 23.33 pg/mL, P < 0.05). However, these hormones returned to the baseline value 7 days after acute PRS. The levels of CORT (20.84 +/- 2.19 ng/mL) and ACTH (200.41 +/- 78.10 pg/mL) in rats with chronic PRS were significantly higher after stress than in rats without PRS (P < 0.05), and these hormones remained elevated 7 days after chronic PRS.

CONCLUSIONS

Both acute and chronic PRS induce reversible visceral hypersensitivity. Acute PRS transiently elevates the plasma levels of CORT and ACTH, whereas chronic PRS has a longer term effect.

Prevalence and clinical significance of superficial abdominal reflex abnormalities in idiopathic scoliosis

To determine prevalence and significance of abnormal superficial abdominal reflexes (SARs) in idiopathic scoliosis. Study of 73 patients with presumed idiopathic scoliosis referred for magnetic resonance imaging (MRI), either as a routine pre-operative assessment (n=42) or because of abnormal symptoms or neurological signs (n=31). All patients were examined prior to magnetic resonance imaging (MRI), and the presence of abnormal SARs was noted. All patients then underwent MRI of the whole spine from the foramen magnum to the sacrum. The presence of Chiari 1 malformation and syrinx was recorded. The study group consisted of 11 males and 62 females with a mean age at time of MRI of 18 years (range 5-51 years) and a mean Cobb angle of 48 degrees (range 10-104 degrees). Abnormality of the SARs was recorded in eight cases (prevalence 11%). An abnormal MRI study was recorded in nine cases (12.3%), all patients having a syrinx and four having in addition, a Chiari 1 malformation. Of the patients with abnormal SARs, only 2 (25%) had an abnormal MRI study; 1 had unilateral absence of the reflexes whereas the other had complete absence of SARs. Of patients referred for MRI as a routine pre-operative assessment, 5 (11.6%) had an abnormal MRI study. In patients with idiopathic scoliosis, abnormality of the SARs was recorded in 11% of cases. Unilateral absence was present in one case only and was associated with the presence of syrinx. Other patterns of abnormality were not a useful indicator of underlying cord abnormality.

Visceromotor and spinal neuronal responses to colorectal distension in rats with aldosterone onto the amygdala

Stereotaxic delivery of corticosterone onto the amygdala produces colorectal hypersensitivity through activation of lumbosacral spinal neurons. Since corticosterone activates both the mineralocorticoid (MR) and glucocorticoid (GR) receptors, the aim of this study was to determine the importance of MRs in the regulation of colorectal hypersensitivity through the use of aldosterone that preferentially binds to MRs. Fischer-344 rats received either aldosterone (n = 18)- or cholesterol (control, n = 18)-containing micropellets bilaterally placed stereotaxically on the dorsal margin of the amygdala. After 1 wk, colorectal sensitivity to distension (30 mmHg) was measured in a subgroup of rats (n = 8/group). In other rats (n = 10/group), extracellular potentials of single L6-S1 spinal neurons in response to colorectal distension (CRD; 10-80 mmHg) were recorded. In aldosterone-implanted rats, CRD produced a greater visceromotor behavioral response compared with cholesterol controls (19 +/- 0.5 vs. 11.5 +/- 2.7; P < 0.01). A total of 68/182 (37%) and 56/167 (34%) of spinal neurons responded to noxious CRD in aldosterone-implanted and control groups, respectively. A total of 36/42 (86%) neurons excited by CRD had spontaneous activity in aldosterone-implanted groups compared with control (19/33, 58%, P < 0.01). Neurons with low thresholds for excitatory responses to CRD were seen more frequently in aldosterone-implanted rats than those in the control group (35/39 vs. 18/31, P < 0.05). Maximal excitatory responses of neurons to CRD in aldosterone-implanted rats were significantly greater (23.9 +/- 2.2 vs. 16.4 +/- 2.0 imp/s, P < 0.05), and the durations were longer (34.3 +/- 2.7 vs. 24.9 +/- 1.4 s, P < 0.05) than those in control group. Finally, a greater number of neurons had wide dynamic range responses to somatic stimulation in aldosterone-treated rats compared with cholesterol controls. Our findings suggest that, in the amygdala, MR receptor-mediated mechanisms are likely involved in descending pathways onto lumbosacral spinal neurons that induce colorectal hypersensitivity to luminal distension.

The hung-up knee jerk in Huntington's Disease

The 'hung-up' knee jerk (HUKJ) is a specific, although rarely appreciated, clinical sign of Huntington's Disease. A HUKJ was present in 11 of 31 consecutive patients with Huntington's Disease seen in our practice. The clinical characteristics of these patients are described and an EMG recording of the HUKJ is presented from one patient. The history of the description of the HUKJ and its neurophysiology are briefly reviewed.

The deep tendon and the abdominal reflexes

The deep tendon reflexes (and the abdominal reflexes) are important physical signs which have a special place in neurological diagnosis, particularly in early disease when they alone may be abnormal. They act as "hard" signs in situations where clinical assessment is complicated by patient anxiety, and become more useful as clinical experience develops.

Neural circuits in swallowing and abdominal vagal afferent-mediated lower esophageal sphincter relaxation

The purpose of this review is to identify the medullary subnuclei that house neural circuits for lower esophageal sphincter (LES) relaxation. LES relaxation may occur as a component of primary peristalsis elicited by superior laryngeal nerve (SLN) afferent stimulation, secondary peristalsis elicited by esophageal distention or as a component of belch reflex, and transient LES relaxation elicited by gastric vagal afferent stimulation. In mice, SLN stimulation at 10 Hz elicited complete swallowing reflex, including pharyngeal and esophageal peristalsis, and LES relaxation. SLN stimulation at 5 Hz elicited pharyngeal contractions and isolated LES relaxation, which is not accompanied by esophageal peristalsis. Electric stimulation of afferents in the ventral branch of the subdiaphragmatic vagus (vSDV) at 10 Hz also elicited isolated LES relaxation. Using these defined stimuli, c-fos expression was examined in the entire craniocaudal extent of the medullary nuclei. SLN stimulation at 10 Hz induced c-fos expression in neurons in: (1) interstitial (SolI), intermediate (SolIM), central (SolCe), occasional medial (SolM), and dorsomedial (SolDM) solitary subnuclei; (2) motor neurons in the nucleus ambiguus, including its semicompact (NAsc), loose (NAl), and compact (NAc) formations; and (3) dorsal motor nucleus of vagus, including its rostral (DMVr) and caudal (DMVc) parts. The activated neurons represent neurons involved with afferent SLN-mediated reflexes, including swallowing. SLN stimulation at 5 Hz evoked c-fos expression in neurons in SolI, SolIM, SolM, and SolDM but not in SolCe; and motor neurons in NAsc, NAl, and DMVc but not in NAc or DMVr. Stimulation of vSDV induced c-fos expression in neurons in SolM and SolDM and in motoneurons in DMVc. When considered with published reports in other animal species, these data support the speculation that (1) swallow-evoked primary peristalsis involves the following neural circuits: SolI/SolIM --> NAsc/NAl for pharyngeal and SolCe --> NAc for esophageal (striated muscle) peristalsis, SolM/SolDM --> preganglionic neurons in DMVc and DMVr and nitrergic and cholinergic neurons in myenteric plexus for esophageal (smooth muscle) peristalsis, and SolM/SolDM --> preganglionic neurons in DMVc --> postganglionic nitrergic neurons in the myenteric plexus for LES relaxation; and (2) abdominal vagus-stimulated isolated LES relaxation may involve neurons in SolM and SolDM --> preganglionic motor neurons in DMVc --> postganglionic nitrergic neurons in the myenteric plexus.

Stimulant action of pituitary adenylate cyclase-activating peptide on normal and drug-compromised peristalsis in the guinea-pig intestine

1. Pituitary adenylate cyclase-activating peptide (PACAP) is known to influence the activity of intestinal smooth muscle. This study set out to examine the action of PACAP on normal and drug-inhibited peristalsis and to shed light on its site and mode of action. 2. Peristalsis in isolated segments of the guinea-pig small intestine was elicited by distension through a rise of the intraluminal pressure. Drug-induced motility changes were quantified by alterations of the peristaltic pressure threshold at which aborally moving peristaltic contractions were triggered. 3. PACAP (1-30 nM) stimulated normal peristalsis as deduced from a concentration-related decrease in the peristaltic pressure threshold (maximum decrease by 55%). The peptide's stimulant effect remained intact in segments pre-exposed to apamin (0.5 microM), N-nitro-L-arginine methyl ester (300 microM), naloxone (0.5 microM), atropine (1 microM) plus naloxone (0.5 microM) or hexamethonium (100 microM) plus naloxone (0.5 microM). 4. PACAP (10 nM) restored peristalsis blocked by morphine (10 microM), noradrenaline (1 microM) or N6-cyclopentyladenosine (0.3 microM) and partially reinstated peristalsis blocked by Rp-adenosine-3',5'-cyclic monophosphothioate triethylamine (100 microM) but failed to revive peristalsis blocked by hexamethonium (100 microM) or atropine (1 microM). The peptide's spectrum of properistaltic activity differed from that of naloxone (0.5 microM) and forskolin (0.3 microM). 5. The distension-induced ascending reflex contraction of the circular muscle was facilitated by PACAP (1-30 nM) which itself evoked transient nerve-mediated contractions of intestinal segment preparations. 6. These data show that PACAP stimulates normal peristalsis and counteracts drug-induced peristaltic arrest by a stimulant action on excitatory enteric motor pathways, presumably at the intrinsic sensory neurone level. The action of PACAP seems to involve multiple signalling mechanisms including stimulation of adenylate cyclase.

Intracolonic glycerol induces abdominal contractions in rats: role of 5-HT3 receptors

Serotonin and 5-HT3 receptors may be involved in the activation of nociceptive afferent pathways by rectal distension. In rats, intracolonic infusion of glycerol is able to trigger nociceptive inputs as evidenced by the occurrence of abdominal constrictions. This work was designed to evaluate the influence of 5-HT3 receptor antagonists on this reflex and to approach the site of action by comparing their relative efficacies according to the route of administration. Male Wistar rats (250-350 g) were surgically prepared for abdominal electromyography and a catheter was placed in the colonic lumen. Five days after surgery, electrical activity of abdominal muscles was recorded before and during (20 min) intracolonic infusion of glycerol (60% glycerol + 40% saline, rate 0.75 mL/h). Cilansetron was administered intraperitoneally, 15 min before glycerol infusion, at doses of 5 to 500 micrograms/kg. Granisetron, ondansetron and cilansetron were administered at the dose of 20 micrograms/kg by intraperitoneal (i.p.), intravenous (i.v.) or intracolonic (i.c.) routes. The number of abdominal spike bursts was used as an index of visceral nociception. Intracolonic infusion of glycerol increased significantly (P < 0.05) the number of abdominal spike bursts during the time of infusion compared with saline (30.6 +/- 6.6 vs 4.5 +/- 3.4 bursts). When administered i.p., cilansetron dose-dependently reduced the frequency of abdominal spike bursts from the dose of 20 micrograms/kg i.p. Administration i.p. of granisetron and ondansetron at this dose also significantly reduced the number of abdominal spikes (19.0 +/- 6.0 and 18.3 +/- 6.9 respectively). Cilansetron, ondansetron and granisetron were also effective by i.v. and i.c. routes, cilansetron was more active by the i.c. route. Serotonin, via 5-HT3 receptors, is involved in the mediation of abdominal contractions induced by intracolonic infusion of glycerol. 5-HT3 receptor antagonists are also active by i.c. route suggesting a local site of action.

Sacral reflex latency correlated by age and sex

This prospective study was undertaken on 190 subjects who had no prior central or peripheral nerve supply pathology and where the value of the sacral reflex latency was compared by age and sex in order to determine precise norms. There were 90 men whose age averaged 56.9 +/- 13 years and 100 women with an average age of 54 +/- 13.1. The reflex was obtained by stimulating the dorsal nerve of the penis and the clitoris and taking a reading in the intermediate part of the external anal sphincter muscle. An averaging technique was used (over 30 stimulation occurrences). The average intensity of the stimulation was 15 mA. The value of the stimulus reaction latency taken at the positive peak was analyzed statistically. The average value was 37.6 +/- 5.36 ms in male subjects and 46.6 +/- 8.08 in female subjects. In men, values varied from 36.6 +/- 4.26 ms at under 35 years of age and reached 42 +/- 3.52 ms at over 75 years. In women, values varied from 37.33 +/- 7.69 ms at under 35 years to 55.6 +/- 4.39 ms at over 75 years of age. In a previous article we discussed ageing features in nerves and muscles. These features are largely responsible for the occurrence of static pelvic problems. The purpose of this study is to compare the sacral reflex latency by sex and age in normal subjects.

Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy

OBJECTIVE

This study was aimed at analyzing the degree of intercostal nerve impairment in posterolateral and muscle-sparing thoracotomy and at correlating the nerve damage to the severity of long-lasting postthoracotomy pain.

METHODS

Neurophysiologic recordings were performed 1 month after either posterolateral or muscle-sparing thoracotomy to assess the presence of the superficial abdominal reflexes (mediated in part by the intercostal nerves), the somatosensory-evoked responses after electrical stimulation of the surgical scar, and the electrical thresholds for tactile and pain sensations of the surgical incision.

RESULTS

The patients who underwent a posterolateral thoracotomy showed a higher degree of intercostal nerve impairment than the muscle-sparing thoracotomy patients as revealed by the disappearance of the abdominal reflexes, a larger reduction in amplitude of the somatosensory-evoked potentials, and a larger increase of the sensory thresholds to electrical stimulation for both tactile perception and pain. In addition, these neurophysiologic parameters were highly correlated to the postthoracotomy pain experienced by the patients 1 month after surgery, indicating a causal role for nerve impairment in the long-lasting postoperative pain.

CONCLUSIONS

This study shows for the first time the pathophysiologic differences between posterolateral and muscle-sparing thoracotomy and suggests that the minor long-lasting postthoracotomy pain in muscle-sparing thoracotomy patients is partly due to a minor nerve damage. In addition, because nerve impairment is responsible for the long-lasting neuropathic component of postoperative pain, it is necessary to match specific treatments to the neuropathic pain-generating mechanisms.

[Pheochromocytoma revealed by cerebral hematomas. Significance of the abolition of a cutaneous abdominal reflex ipsilateral to the adrenal tumor]

Cerebro-vascular complications of pheochromocytoma are now rare. The case reported here is a 47-year-old woman who presented with two cerebral hematomas and a pheochromocytoma. Abolition of a cutaneous abdominal reflex abolition can help the clinician to locate the adrenal tumor side.

Abdominal reflexes

Examination of the superficial abdominal reflexes in patients thought to have idiopathic scoliosis has been considered possibly beneficial for deciding who should have magnetic resonance imaging to rule out syringomyelia. The purpose of this study was to determine what is normal for this examination. Thirty normal adolescents and 35 normal young adults underwent testing of the superficial abdominal reflexes and the patellar and Achilles deep tendon reflexes. Each test was repeated two times. Thirty-nine (60%) subjects had bilaterally equal abdominal reflexes. Nine (14%) subjects had asymmetric reflexes, and seven (11%) subjects had no reflex in at least one quadrant. No subjects had reflexes present on one side and absent on the other. Ten (15%) subjects had absence of the abdominal reflexes in all quadrants. Sixteen (25%) subjects had extinguishing of the reflex in at least one quadrant as the test was repeated. Eleven of these had asymmetric or partially absent reflexes initially. In contrast, the patellar and Achilles reflexes were more consistent. The patellar reflexes were bilaterally equal in 52 (85%), asymmetric in eight (13%), and absent in one (2%). The Achilles reflexes were bilaterally equal in 59 (97%), asymmetric in one (2%), and absent in one (2%). The finding of abdominal reflexes consistently present on one side and consistently absent on the other side did not occur in our normal subjects. This finding might warrant further workup if found in a patient with scoliosis. Other variations in abdominal reflex testing such as asymmetries, absent in some quadrants, and absent in all quadrants are fairly common in normal subjects.

Absent superficial abdominal reflexes in children with scoliosis. An early indicator of syringomyelia

We describe 12 children with idiopathic scoliosis who had a persistent absent superficial abdominal reflex (SAR) on routine neurological examination. MRI showed syringomyelia to be present in ten. The average age at detection of the scoliosis was 4.3 years and at diagnosis of syringomyelia 6.6 years. In all ten children the SAR was consistently absent on the same side as the convexity of the curve. In two it was the only abnormal neurological sign. An absent SAR in patients with scoliosis is an indication for investigation for underlying syringomyelia. In the children with syringomyelia, six had thoracic and four thoracolumbar curves. The clinical features differed in the two groups. Patients with thoracic curves were generally asymptomatic. Their neurological signs were subtle and none had any motor signs. By contrast, patients with thoracolumbar curves had symptoms and neurological signs. Abnormal gait was present in all four patients with thoracolumbar curves. In three this was due to considerable motor weakness. In eight children syringomyelia was associated with a Chiari-I malformation. In seven the syrinx was treated surgically by decompression of the foramen magnum.

Electrophysiological study of superficial abdominal reflexes in normal men

We studied the superficial abdominal reflexes of 83 normal men, using as stimuli a train of electrical pulses or a needle scratch. Electrical stimulation delivered to the midline of the abdominal wall evoked, almost symmetrically on both sides, two reflex discharges: an early response having an oligophasic wave form, and a late response of polyphasic wave form. The threshold of the early response significantly exceeded that of the late response. With repetitive stimulation, the late response generally revealed habituation. Electrical stimulation of the unilateral abdominal wall evoked two responses on the stimulated side, whereas it evoked only the late response on the contralateral side. A needle scratch on the unilateral abdominal wall evoked one reflex discharge with a long latency and a polyphasic wave form. This response occurred generally on the stimulated side and became habituated to repeated scratching. These observations suggest that the superficial abdominal reflexes elicited by electrical stimulation are composed of two reflex discharges with a different reflex arc. They appear to closely resemble the blink reflex. The response elicited by needle scratching is thought to correspond to the late response of the electrically elicited abdominal reflexes.