In tetanus

An adjunct for the relief of skeletal muscle spasm caused by reflex spasm to local pathology (such as inflammation of the muscles or joints, or secondary to trauma) spasticity caused by upper motor neuron disorders athetosis stiff-man syndrome. Injectable diazepam may also be used as an adjunct in tetanus. 

Nondepolarizing blockers are used to relax skeletal muscle for surgical procedures, to prevent dislocations and fractures associated with electroconvulsive therapy, and to control muscle spasms in tetanus. They do not produce anesthesia or analgesia. 

The activity of muscles is controlled by ACH and NA. It is plausible that an inhibition or activation of neurotransmitter-regulated ion channels will severely influence muscular reactivity and thus the mobility or organ function (heart, blood vessels, lungs, gut) of an animal. In the case of inhibition, muscles will relax in the case of overstimulation, muscles will be tense or in tetanus, leading to a general paralysis. 

Maximal release of acetylcholine by the motoneurons occurs in tetanus, due to the toxin-mediated inactivation of glycinergic neurons that normally inhibit them. This results not in blockade but maximal muscle activity, so strong that bone fractures are commonly observed. However, blockade can be observed with inhibitors of acetylcholine esterase (see below). 

Paralysis can take place anytime there is a failure or interference in the transfer of biochemical impulses from nerve to muscle. On the other hand, hyperactivity of neuromuscular transmission can lead to minor twitches and cramps or to severe spasms as in tetanus (lockjaw) or amyotrophic lateral sclerosis (Lou Gehrig disease). There is still much to learn about both hyperactive and paralytic cases, but new research on DNA and immunology is proving helpful. 

Severe cases of tetanus generally require admission to an intensive care unit for 3-5 weeks. Weight loss is universal in tetanus and these patients require enteral nutrition. Other important measures include close control of fluid balance, chest physiotherapy to prevent pneumonia, prophylaxis of thromboembolism and intensive nursing care to prevent pressure sores. 

The ability of tetanus toxin to interact with thyroid membranes and with TSH receptors on these membranes, as suggested above, has several significant implications and applications. An obvious clinical implication is that the syndrome of sympathetic overactivity which can appear in tetanus is contributed to by the ability of the toxin to induce thyroid hyperfunction. This syndrome would thus be analogous in its etiological relationship to the thyroid as is thyroid storm or as is the hypersensitivity to... 

Bll. Brody, I. A., and Hatcher, M. A., Origin of increased serum creatine kinase in tetanus. Arch. Neurol. 16, 89-93 (1967). 

Methocarbamol is a centrally acting skeletal muscle relaxant. A carbamate derivative of guaifenesin (1.5 g p.o. q.i.d.), methocarbamol is used as an adjunct in acute, painful musculoskeletal conditions and in supportive therapy in tetanus management. 

Tetanus immune globulin, an immune serum with tetanus prophylaxis effectiveness, is used in tetanus exposure and tetanus treatment. 

Fig. 8. Temperature dependence of tension. Curve 1 model fiber (A. Weber, 1951) la, actomyosin thread (Portzehl, 1950b), both in 3 X 10 M ATP curve 2 model fiber in 4 X 10 M ATP curve 3, model fiber without ATP (A. Weber, 1951) curve 4 muscle in tetanus (from A. V. Hill, 1951) curve 5 resting muscle (from Josenhans, 1949).

Kodes of Application.—Internally —Diluted with water. In troublesome cough in horses, twenty minims of the acid with a drachm each of camphor and extract of belladonna, made into a ball with powdered liquorice or linseed meal, and given two or three times a day. To the dog, in obstinate vomiting, two grains of the add with ten grains of carbonate of soda and one ounce of water may be administered every hour. One drachm of the add with about a quart of water, employed slowly as an enema two or three times a day, lessens muscular contn ons in tetanus. Externally — To allay pain and irritation in chronic skin affections, especially in dogs, two to three drachms of the acid are mixed with a pint of distilled or rain water. 

Reaction of aldehydes with the indole NH group of tryptophan in proteins has been reported in tetanus toxin (251) and tobacco mosaic virus (26). In the latter instance, the Folin s phenol reagent color value decreased as the reaction with formaldehyde proceeded, and increased with removal of the aldehyde by dialysis in dilute acid. Indole, pure tryptophan, and glycyl tryptophan behaved in a similar manner, but not t3unsine nor glycyltyrosine. Benzaldehyde, acetaldehyde, propionalde-hyde, and butyraldehyde were also used in this work with similar effect. Reversal of formaldehyde inactivation of tobacco mosuc virus could not be confirmed (356). It was also claipaed that the drop in phenol color could not be correlated with a decrease in virus infectivity. 

Saissy JM, Vitris M, Demaziere J, Seek M, Marcoux L, Gaye M. Flumazenil counteracts intrathecal baclofen-induced central nervous system depression in tetanus. Anesthesiology 1992 76(6) 1051-3. 

In a study of neurodevelopment in infants at 6 months who had been exposed in utero to thimerosal in tetanus-diphtheria vaccines during pregnancy there were no differences from infants who had not been exposed [4Pf. Although there was a significant correlation between the concentration of mercury in the hair of the mothers and the hair of the neonates, there was no correlation between the degree of in utero exposure to ethylmercury and mercury concentrations in neonatal hair. 

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