Lumbarization

Water-soluble contrast media (CM) are preferred because of effective mixing with CSF, plus the radiopaque is absorbed and effectively excreted in the urine, and does not have to be physically removed from the subarachnoid space after the procedure. Sodium methiodal, the first water-soluble agent used for myelography, produced neurotoxicity problems when exposed to the cells of the spinal cord and brain, thus limiting utility to the lumbar region and requiring the appHcation of spinal or general anesthesia. 

Chymopapain [9001 -90-6] derived from the latex of the papaya tree, produces improvement in lower back pain and sciatica in the majority (75%) of recipients (185—189) when injected into the lumbar intervertebral disks of patients suffering from herniated disk (the nucleus pulposus). This treatment degrades the proteoglycans of the diseased nucleus pulposus, resulting in shrinkage of the disk and reduction of pressure on the nerve roots (190). 

CoUagenase specifically cataly2es the hydrolysis of coUagen, and is used in debridement of dermal ulcers and bums (191). It, like chymopapain, is also useful in the treatment of herniated lumbar disks (192,193). The rationale for coUagenase treatment in this instance is based on the preponderance of coUagen in herniated disk tissue, and the inabiUty of other en2ymes to dissolve coUagen (194). 

Tetracaine is a substance used medicinally as a spinal anesthetic during lumbar punctures (spinal taps). 

Administration of a drag into the cerebrospinal fluid (liquor cerebrospinalis), by performing either a lumbar or a ventricular injection. 

Spinal anesthesia is a type of regional anesthesia that involves the injection of a local anesthetic drug into the subarachnoid space of die spinal cord, usually at the level of the second lumbar vertebra There is a loss of feeling (anesdiesia) and movement in the lower extremities, lower abdomen, and perineum. 

Minor surgery within past 10 days, including liver and kidney biopsy, thoracocentesis, lumbar puncture ... 

Lamina VI forms the base of the dorsal horn and can be found only in certain levels of the spinal cord, the cervical and lumbar regions. Few data have been reported on the cell composition of lamina VI. Cells of lamina VI are small compared to those of lamina V and some axons appear to contribute to the STT and SCT pathways. 

Studies have demonstrated that treatment with soy or phytoestrogen enriched diets is effective in conserving bone in rodent models of osteoporosis (Anderson and Gamer, 1998 Ishimi et al, 2000 Draper et al, 1997). The mechanism of action of phytoestrogens on bone health is unclear but several mechanisms including inhibition of bone resorption and stimulation of bone formation maybe involved (Fanti etal, 1998 Ishimi e/a/., 1999 Picherit eta/., 2000). Limited data from studies in postmenopausal women have indicated that phytoestrogen supplements have a small, beneficial effect on bone loss in the lumbar spine (Alekel et al, 2000 Potter et al, 1998 Somekawa et al, 2001). 

Horiuchi et al., 2000 Japanese postmenopause n = 85 Women with a high soy protein intake showed less bone loss and higher BMD at the lumbar spine Biomarkers urinary deoxypyridinoline (bone resorption) decreased... 

Mei et al., 2001 Chinese postmenopause n = 357 premenopause n = 293 Significant differences found in BMD of the lumbar spine and hip between highest and lowest tertile of isoflavone intake for postmenopausal but not for premenopausal women... 

Somekawa et al., 2001 Japanese peri/post-menopause n = 478 The high isoflavone intake group (65 mg/d) had significantly higher BMD of the lumbar spine compared to the low intake group (35 mg/d). Some menopausal symptoms were better alleviated in the high vs low intake group... 

Potter et al., 1998 American postmenopause n = 66 40 g soy protein (containing 90 mg isoflavones/ day) over 6 months results in 2.5% increase in BMD of the lumbar spine... 

Morabito et al., 2002 European postmenopause placebo, n = 30 genistein, n = 30 HRT, n = 30 First randomized, double-blind placebo-controlled study. Compared to placebo control, genistein (54 mg/day) consumed for 1 year significantly reduced urinary excretion of bone resorption markers and increased bone formation markers at 6 and 12 months BMD was significantly increased at the femoral neck and lumbar spine plasma genistein concentration was around 1.5 pM. HRT showed similar effects to genistein for BMD. 

Arjmandi et al., 1996 95 d old OVX rats 30 d soy protein with isoflavones (8 mg/d) starting at OVX Prevention of bone loss soy protein/isoflavones prevented the BMD losses in the femur and d lumbar vertebra after OVX... 

KOMULAINEN M, KROGER H, TUPPURAINEN M T, HEIKKINEN A M, ALHAVA E, HONKANEN R, lURVELIN I and SAARiKOSKi s (1999) Prevention of femoral and lumbar bone loss with hormone replacement therapy and vitamin D3 in early postmenopausal women a population-based 5-year randomized trial. J Clin Endocrinol Metab 84, 546-52. 

There are several ways in which possible neurotoxic effects might be studied. First, measurement of cerebrospinal fluid concentrations of dopamine or serotonin metabolites would be a straightforward way of assessing neurotoxicity. There are pitfalls in this approach (as outlined by Dr. Ricaurte (this volume), such as the facts that lumbar cerebrospinal fluid might reflect spinal cord neurochemistry more than it reflected brain neurochemistry, and drugs like /r-chloroamphetamine affect serotonin neurons in spinal cord less than they do those in brain (Sanders-Bush... 

Lumbar puncture within 7 d Noncompressible vascular punctures Active peptic ulcer disease Pregnancy For streptokinase/... 

In placebo-controlled clinical trials, alendronate, ibandronate, and risedronate increased bone mineral density by up to 5% to 8% in the lumbar spine and up to 3% to 5% in the hip.13-16 Additional data suggest that bone mineral density continues to increase with long-term therapy of 7 to 10 years.17,18... 

Plaques appear most commonly on the elbows, knees, scalp, umbilicus, and lumbar areas, and often extend to involve the trunk, arms, legs, face, ears, palms, soles, and nails. 

Evaluation Physical examination, complete blood count (CBC) with reticulocyte, urinalysis, chest x-ray, and cultures (blood, urine, and throat) lumbar puncture if toxic-looking or presenting with signs of meningitis needle aspirate in patients with findings suggestive of osteomyelitis... 

Protuberant abdomen with exaggerated lumbar lordosis, usually an asthenic appearance with rather long extremities and tapered fingers, and frequently a barrel-shaped chest... 

Ideally, lumbar puncture to obtain cerebrospinal fluid (CSF) for direct examination and laboratory analysis, as well as blood cultures and other relevant cultures, should be obtained before initiation of antimicrobial therapy. However, initiation of antimicrobial therapy should not be delayed if a pretreatment lumbar puncture cannot be performed. 

CSF examination via lumbar puncture (LP, spinal tap) contraindicated in patients with cardiorespiratory compromise,... 

Immunocompromised, history of CNS disease, new onset seizure, papilledema, altered consciousness, or focal neurologic deficit or delay in performance of diagnostic lumbar puncture... 

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