Thesis (M.App.Sc. in Physiotherapy)--University of South Australia, 1997.

Thesis (MPhysio)--University of South Australia, 1998

Thesis (MAppSc) -- University of South Australia, 1998

M.Tech. (Chiropractic) / Please refer to full text to view abstract

M.Tech. (Chiropractic) / The purpose of this study was to compare the immediate effect of upper versus lower cervical manipulation on the vertebral artery blood flow in asymptomatic individuals. Thirty patients of both genders between the ages of 18-45 years of age, volunteered to participate in this study. Each participant presented with at least one upper and one lower rotary cervical facet restriction. Each participant was randomly placed into either Group 1 whom received upper cervical manipulation, or Group 2 whom received lower cervical manipulation. Any participants who presented with positive VBAI signs or symptoms were excluded from this study. The Medison SonoAce 8000 Ultrasound System was used to objectively measure the blood flow as close to C1-C2 region as possible, contralateral to the side of the adjustment contact. Three measurements were recorded in total which included neutral, pre-manipulation and post-manipulation. As this study included asymptomatic participants, no subjective data was collected. Statistical analysis was performed where the intragroup analysis was done using the Paired Sample t-test and inter-group analysis was done using the Independent Samples t-test to check for statistically significant results less than the p-value of 0.05. There were no statistically significant results found in Group 1 and Group 2 in isolation in the intragroup analysis as well as when compared in the intergroup analysis. Upper cervical manipulation resulted in a slight percentage increase in mean blood flow velocity. Lower cervical manipulation resulted in a decreased end diastolic blood flow velocity after manipulation which indicated the possibility of vertebrobasilar occlusion, however, it did not result in much change with regards to mean blood flow velocity. In addition, upper as well as lower cervical v manipulation had a minimally insignificant dilating effect on the diameter of the upper vertebral artery which may have been due to reflex vasodilation. This study demonstrated no statistically significant changes in isolation in the intragroup analysis as well as when compared in the intergroup analysis. Lower cervical manipulation did however have a moderate influence on the upper vertebral artery blood flow but overall was still less stressful in comparison to upper cervical manipulation. Additional studies are suggested to clarify these findings further.

The research described in this thesis began with a single long-term objective: modelling of the vertebral artery during chiropractic manipulation of the cervical spine. Although chiropractic treatment has become prevalent, the possible correlation between neck manipulation and subsequent stroke in patients has been the subject of debate without resolution. Past research has been qualitative or statistical, whereas resolution demands a fundamental understanding of the associated mechanics.<p> Analysis in the thesis begins with a study of the anatomy and properties pertinent to the chiropractic problem. This indicates that the complexity of the problem will necessitate a long-term multidisciplinary effort including a nonlinear finite element formulation effective in analysing image data for soft tissue modelled as nearly incompressible. This leads to an assessment of existing finite element methods and the conclusion that new equation solving techniques are needed to ensure numerical stability.<p> Three techniques for effectively eliminating the source of numerical instability are developed and demonstrated with the aid of original finite element codes. Two of the methods are derived as modifications of matrix decomposition algorithms, while the third method constitutes a new finite element formulation. In addition, the understanding gained in developing these methods is used to produce a theorem for assessing a different but related problem: deformation of a nearly incompressible material subjected to a single concentrated force. Throughout the thesis, an interdisciplinary path from chiropractic problem to numerical algorithms is outlined, and results are in the form of mathematical proofs and derivations of both existing and new methods.

The research described in this thesis began with a single long-term objective: modelling of the vertebral artery during chiropractic manipulation of the cervical spine. Although chiropractic treatment has become prevalent, the possible correlation between neck manipulation and subsequent stroke in patients has been the subject of debate without resolution. Past research has been qualitative or statistical, whereas resolution demands a fundamental understanding of the associated mechanics.<p> Analysis in the thesis begins with a study of the anatomy and properties pertinent to the chiropractic problem. This indicates that the complexity of the problem will necessitate a long-term multidisciplinary effort including a nonlinear finite element formulation effective in analysing image data for soft tissue modelled as nearly incompressible. This leads to an assessment of existing finite element methods and the conclusion that new equation solving techniques are needed to ensure numerical stability.<p> Three techniques for effectively eliminating the source of numerical instability are developed and demonstrated with the aid of original finite element codes. Two of the methods are derived as modifications of matrix decomposition algorithms, while the third method constitutes a new finite element formulation. In addition, the understanding gained in developing these methods is used to produce a theorem for assessing a different but related problem: deformation of a nearly incompressible material subjected to a single concentrated force. Throughout the thesis, an interdisciplinary path from chiropractic problem to numerical algorithms is outlined, and results are in the form of mathematical proofs and derivations of both existing and new methods.

Orientador: Simone Appenzeller / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T16:23:29Z (GMT). No. of bitstreams: 1 Santos_Elizangelados_D.pdf: 1569830 bytes, checksum: 0312d7e3143dbf6847b4b3af7e90d245 (MD5) Previous issue date: 2013 / Resumo: Objetivo: Verificar se há uma associação entre a espondilose cervical, sinais e sintomas auditivos e alterações no fluxo da artéria vertebral. Material e método: Foram selecionados 150 indivíduos que freqüentavam a Universidade Aberta à Terceira Idade da Universidade Federal de Alfenas. Foram excluídos indivíduos com traumas, doenças sistêmicas ou locais que pudessem interferir com o sistema auditivo e vestibulococlear . No total, 102 indivíduos [91 (89,2%) do sexo feminino; média de idade de 59,4± 12,0 anos (variação de 30 a 91 anos)]. A presença de sinais e sintomas auditivos foi avaliada através de uma anamnese elaborada específicamente para esse fim. Radiografias nas posições anteroposterior, perfil e oblíquas foram realizadas em todos os indivíduos e analisadas por dois radiologistas, cegos em relação a sintomatologia. Ultrassonografia (US) Doppler foi realizada nas artérias vertebrais direita e esquerda em posição anatômica em todos os indivíduos, por um ultrassonografista cego quanto às manifestações clínicas ou radiográficas. A análise estatística foi realizada no programa SAS e Systat. Os testes estatísticos aplicados foram selecionados de acordo com a natureza das variáveis. Resultados: A prevalência de sintomas vestibulococleares foi observada em 83 (81,4%) dos indivíduos da amostra. Espondilose cervical foi observada em 71 (69,6%) dos indivíduos. A média de fluxo da artéria vertebral direita foi significativamente menor [85,3 ± 43,1 ml/min (variação 18,1 ¿ 208,9 ml/min)] quando comparados aos indivíduos sem espondilose cervical [101,2 ± 44,3 ml/min (variação 43,8 ¿ 282,3 ml/min; p=0,02). Não observamos alterações no fluxo arterial vertebral esquerda em pacientes com espondilose cervical, comparado aos indivíduos sem espondilose cervical. Não houve relação entre a alteração do fluxo arterial vertebral, a presença de espondilose cervical e sintomas vestibulococleares. Conclusão: Observamos uma elevada prevalência de sintomas vestibulococleares e espondilose em nossa amostra. O fluxo da artéria vertebral direita estava reduzido em indivíduos com espondilose, porém não houve associação com sintomas clínicos / Abstract: Objective: To determine the relationship between in signs and symptoms of hearing, espondylosis and vertebral artery flow. Methods: A total of 150 individuals from the Universidade aber ta a tercei ra idade da Universidade Federal de Al fenas were invi ted. Individuals wi th t rauma, systemic or local diseases that could inf luence vest ibulococlear symptoms were excluded. A total of 102 individuals[91 (89.2%) female; median age 59,4± 12,0 years (range 30 a 91 years)] were included. Vestibulocolcear symptoms were evaluated by clinical interview. X-ray of the cervical spine were done in anterior-posterior, lateral and oblique view and reviewed by two radiologist blind to the individuals' symptoms. Doppler ultrasound (US) of the vertebral artery was done in anatomic position in all individuals by an ultrasound expert blind to individuals characteristics. Statistics was performed using SAS and Systat according to the nature of the variable. Results: The prevalence of signs and symptoms of hearing was observed in 83 (81.4%) and spondylosis in 71 (69.6%) individuals. The mean right vertebral flow was significant smaller in individuals with spondylosis [85.3 ± 43.1 ml/min (range18.1 ¿ 208.9 ml/min)] when compared to individuals without spondylosis. We did not observe a difference regarding the left vertebral flow. No relation between arterial vertebral flow, spondylosis and vestibulocolear symptoms was observed. Conclusion: A high prevalence of vestibulococlear symptoms and spondylosis was observed in this cohort. The right vertebral artery had reduced flow in individuals with spondylosis, however no relation to symptoms was observed / Doutorado / Clinica Medica / Doutora em Clínica Médica

Abstract The aim of this study was to analyze angiographic findings and the presence and topography of cerebral ischemic and/or hemorrhagic lesions in cerebral CT or MRI, and to assess the long-term clinical outcome of a series of 136 consecutive cervicocephalic artery dissection (CCAD) patients. Pulsatile tinnitus was evaluated as a symptom of CCAD. Medical records and films were reviewed retrospectively. Irregular stenosis was found in angiography in 50% and occlusion in 33% of the dissected cervicocephalic arteries. Irregular stenosis normalized in 81% and occlusion recanalized in 34%. Other findings, such as pseudoaneurysms, intimal flaps, double lumens, and irregular dilatations were rare and often remained unchanged in follow-up. Pulsatile tinnitus was a presenting symptom in 12% of the CCAD patients, but the majority of patients had concomitant head or neck pain, ischemic brain symptoms, Horner's syndrome, or cranial neuropathies. Of the 131 patients who underwent brain imaging, 73 (56%) had signs of infarction in cerebral CT or MRI. Occlusion of the dissected vessel was accompanied by infarction in 76%, irregular stenosis in 40%, and other findings only rarely. Of the anterior circulation infarctions, 95% (39/41) were territorial, subcortical, or territorial infarctions with fragmentation and could thus be considered embolic. Subarachnoid hemorrhage was found in CT in 5 of the 22 patients (23%) with intracranial dissection. The patient's long-term clinical outcome was assessed using two methods: a classification into categories based on neurological symptoms and defects and the modified Rankin Scale (mRS). Of the 136 CCAD patients, 60% recovered with no or mild disability and 79% scored 0–2 on mRS. In the case of dissection of one or more cervicocephalic arteries without occlusion, the figures were 75% and 89%. In the case of occlusive dissection of one or more arteries, only about 35% of the patients recovered well, having no or mild disability, and 61% scored 0–2 on mRS. No significant differences were seen in recovery after intra- and extracranial dissections. In conclusion: irregular stenosis, which is the most common angiographic finding in CCAD, is associated with brain infarction less frequently than occlusion, and the long-term clinical outcome is good in most cases. Occlusion of the dissected vessel causes more brain infarctions, and only about 35% of the patients recover well, having no or mild disability. More than 10% of CCAD patients have pulsatile tinnitus as a presenting, and sometimes the only symptom.

Traumatic arteriovenous fistulas of the neck are a relatively uncommon injury, whose ramifications can include immediate or delayed neurological insults, massive bleeding, or death. Angiography and embolization have been increasingly used to manage this complex injury pattern. In this particular case, the patient underwent management of bilateral communicating arteriovenous fistulae using a commercially available plug occlusion device. Epidemiology, with an emphasis on patient management and outcomes, is discussed.