Guillian-Barré syndrome--a case study

'Acute Guillian-Barré Syndrome is an acute inflammatory demyelinating disease of the peripheral nerves' (Pfister & Bullas 1990) which affects the normal transmission of electrical impulses along these nerves and consequently the function of the organs and tissues which they innervate (Springhouse 1998, Waldock 1995). This disorder can rapidly replace an individual's busy and active lifestyle with one of total dependence, often lasting months (Waldock 1995). It is important, therefore, that nurses understand the pathophysiology of the disease and its effect on the organs and tissue within the body, to enable them to provide a high standard of care for patients suffering from this condition. This discussion of Guillian-Barré Syndrome (GBS) will be in relation to patient (who shall be called Jane Smith for the purpose of this discussion) who was admitted to the Accident and Emergency (A&E) department and diagnosed with GBS (see Box 1 for patient history). Within this discussion GBS will be defined and its pathophysiology explained. The epidemiology and aetiology of the disease will also be highlighted. The majority of the discussion will focus on the physiological effects of GBS on the components of the peripheral nervous system and the appropriate assessment and treatment measures. Finally, the outcomes of the disease will be highlighted. The focus will be on the management of this condition within the A&E department.     

The Functional MR study of motor cortex

By certain functional stimulates, the brain cortex becomes active. The MR scan has been proven to image these cortex activities by comparing the images with and without functional stimulates. The signal differences between the image with and without functional stimulates is related with the hemodynamic and metabolic changes induced by functional activities. This signal difference is very small, but detectable by MR system, and is the functional MR signal. The MR scan displaying the functio…     

How many subjects constitute a study?

In fMRI there are two classes of inference: one aims to make a comment about the "typical" characteristics of a population, and the other about "average" characteristics. The first pertains to studies of normal subjects that try to identify some qualitative aspect of normal functional anatomy. The second class necessarily applies to clinical neuroscience studies that want to make an inference about quantitative differences of a regionally specific nature. The first class of inferences is adequately serviced by conjunction analyses and fixed-effects models with relatively small numbers of subjects. The second requires random-effect analyses and larger cohorts.     

Ultrasonic study of homœopathic solutions

Ultrasonic velocity and absorption measurements have been performed in homœopathic solutions and in corresponding placebo solutions. The possibility of microstructural differences between ‘normal water’ and ‘homœopathic’ water solutions was investigated by propagation of ultrasonic waves in diluted water-ethanol mixtures. Our spectroscopic results do not display any difference between the two liquid systems.     

Repeated visual and computer-assisted carotid plaque characterization in a longitudinal population-based ultrasound study: the Tromsø study

In a longitudinal population-based ultrasound survey, we evaluated the reproducibility of carotid plaque detection, off-line vs. online visual classification of plaque echogenicity and computer-assisted plaque echogenicity (grey-scale median, GSM) classification and plaque area measurements. The number of paired observations in the reproducibility analyses was 107 in the baseline study and 83 in the follow-up study. In addition, 198 and 222 images were selected from the baseline and the follow-up study for GSM- and plaque-area analyses. The total number of plaque images (11,160) was used to obtain comparative reference values. Despite good agreement in the reproducibility study (kappa values ranging from 0.52 to 0.57), there was a substantial drift in online visual classification of plaque echogenicity during the survey period. Inter- and intraobserver agreement on computer-assisted GSM classification was substantial, with kappa values (95% CI) of 0.77 (0.73 to 0.80) and 0.79 (0.75 to 0.84), respectively. A systematic bias in plaque area measurements was observed. Visual online classification may introduce systematic measurement errors that are not intercepted in a reproducibility study of restricted duration. Computer-assisted off-line classification had better reproducibility. However, the method is influenced by measurement errors, both in the outlining of the plaque and in the standardization procedure.     

Exanthema after a stress Tc‐99m sestamibi study: continue with a rest sestamibi study?

Purpose: A mild allergic reaction assumed to be caused by injection of Tc-99m sestamibi for a stress myocardial perfusion imaging (MPI) is presented. We want to discuss the risk involved in completing the MPI with another sestamibi injection, and the precautions and possible treatment in case of a further reaction. Material and methods: A patient experienced a maculo-papular exanthema, i.e. a mild, probably allergic, adverse event (AE) after a stress MPI including administration of a dose of Tc-99m sestamibi. A rest MPI was needed to decide whether coronary bypass surgery should be performed. After prophylactic treatment with antihistamine and corticosteroid, an uneventful rest MPI was performed. Discussion and conclusion: International recommendations or guidelines related to treatment of AEs after nuclear medicine studies do not exist. Serious AEs in nuclear medicine are very rare, but anaphylactic reactions have been reported and may be life threatening. If repeated administration of the radio-pharmaceutical must be given, the prophylactic and therapeutic interventions should follow general international guidelines for allergic reactions.     

Burden of chemotherapy-induced neuropathy��a cross-sectional study

Background  

Neuropathy is a common adverse effect of chemotherapy. However, the both the prevalence and the burden of this adverse effect have been poorly documented. The aim of the study was to assess the prevalence and discomfort caused by neuropathic symptoms in relation to other adverse effects of chemotherapy.     

Electrophsiological study in the prognosis of Bell palsy

AIM:To estimate the prognosis of Bell palsy,METHODS:Blink relex (BR),electromyography(EMG),motor latency(ML) and amplitude (AMP) of facial nerve were performed in 42 patients with Bell‘‘‘‘s palsy.The patients were followed about half a year.RESULTS:(1) When 1 of the 3R waves related with the ill side existed or appeared in 3 weeks after onset,97% patients could recover completely.THe recovery time was realted to the time of the occurrence of R wave.(2) When 1 of the 3R waves appeared in the 4th week.60% patients could recover completely,When none of the 3 wasves appeared after the 4th week,100% patients could not recover completely.EMG showed spontaneous activities in 3 of the 6 patients in the 4th week.(3) Motor latency and amplitude of facial nerve were examined when the illness stopped developing.All patients had normal lalencies,5 patinets‘‘‘‘ amplitudes reduced more than 90%.3 of the 5 patients did not appear the related R waves after the 4th week.CONCLUSION:BR might provide the early sign of good prognosis of Bell‘‘‘‘s palsy ,BR together with EMG and ML and AMP of facial nerve might provide the later sign of poor prognosis.     

Does intraosseous equal intravenous? A pharmacokinetic study

Study Objective

Despite the growing popularity of intraosseous infusion for adults in emergency medicine, to date there has been little research on the pharmacokinetics of intraosseously administered medications in humans. The objective of the study was to compare the pharmacokinetics of intraosseous vs intravenous administration of morphine sulfate in adults.

Methods

The study followed a prospective, randomized, crossover design. Each subject was equipped with an indwelling intraosseous access device and an intravenous line. Subjects were randomized to receive a 5-mg bolus of morphine sulfate infused intraosseously or intravenously, followed by the alternate administration route 24 hours later.Serial venous blood samples (5 mL) were taken at baseline and at 13 time points over 8 hours postinfusion. Blood samples were analyzed for morphine concentration by radioimmunoassay. Pharmacokinetic parameters were calculated from the data, including maximum plasma concentration (C_max), time to maximum concentration (T_max), and area under plasma concentration-time curve (AUC), among others. Data were analyzed by analysis of variance.

Results

No statistically significant differences were observed between intraosseous and intravenous administration of morphine sulfate for nearly all of the pharmacokinetic parameters including C_max (235 ± 107 vs 289 ± 197 ng/mL, mean ± SD, IO vs IV, respectively), T_max (1.3 ± 0.5 vs 1.4 ± 0.5 minutes), and AUC_(0-∞) (4372 ± 1785 vs 4410 ± 1930 ng min⁻¹ mL⁻¹). There was, however, a statistically significant difference in the volume of distribution in the central compartment, V_d (P = .0247), which in the opinion of the investigators was thought to be due to a minor deposition effect near the intraosseous port or in the bone marrow.

Conclusion

The results support the bioequivalence of intraosseous and intravenous administration of morphine sulfate in adults.