Relationship between EMG-detected and ultrasound-detected fasciculations in amyotrophic lateral sclerosis: A prospective cohort study

ObjectivesFasciculation potentials (FP) are an important consideration in the electrophysiological diagnosis of ALS. Muscle ultrasonography (MUS) has a higher sensitivity in detecting fasciculations than electromyography (EMG), while in some cases, it is unable to detect EMG-detected fasciculations. We aimed to investigate the differences of FP between the muscles with and without MUS-detected fasciculations (MUS-fas).MethodsThirty-one consecutive patients with sporadic ALS were prospectively recruited and in those, both needle EMG and MUS were performed. Analyses of the amplitude, duration, and number of phases of EMG-detected FPs were performed for seven muscles per patient, and results were compared between the muscles with and without MUS-fas in the total cohort.ResultsThe mean amplitude and phase number of FP were significantly lower in patients with EMG-detected FP alone (0.39 ± 0.25 mV and 3.21 ± 0.88, respectively) than in those with both FP and MUS-fas (1.22 ± 0.92 mV and 3.74 ± 1.39, respectively; p < 0.0001 and p = 0.017, Welch’s t-test).ConclusionSmall FP may be undetectable with MUS. MUS cannot replace EMG in the diagnostic approach for ALS.SignificanceClinicians should use a combination of EMG and MUS for the detection and quantitative analysis of fasciculation in ALS.     

足底深支或(和)第一跖背动脉逆行足背岛状皮瓣的临床应用

目的探索足部远端软组织缺损修复的较佳方法。方法采用足底深支或(和)第1跖背动脉逆行足背岛状皮瓣对6例足部远端软组织缺损创面进行修复。结果6例患者均一次性修复,软组织缺损最大面积8cm×6cm,术后随访1~4年,足部功能与外观均较满意。结论足底深支或(和)第1跖背动脉逆行足背岛状皮瓣血管解剖比较恒定,操作简单,是修复足远端软组织缺损的较好方法。     

Electrophysiological evaluation in 4 patients with diabetic pseudotabes

BACKGROUND: Researches on diabetic nervous system lesion are mainly focus on peripheral nerve and vegetative nerve, so there are few investigations on diabetic pseudotabes. OBJECTIVE: To investigate the electrophysiological examinations on the diagnosis of diabetic pseudotabes. DESIGN: Case study. SETTING: Department of Electrophysiology and Department of Neurology, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTS: A total of 4 patients with type 2 diabetes mellitus, including 3 males and 1 female aged from 50 to 72 years, were selected from Department of Neurology, Zhongshan Hospital Affiliated to Xiamen University from March 2002 to February 2005. All accepted subjects met the modified diagnostic criteria of diabetes mellitus, which was set by American Diabetes Mellitus Association (ADA) in 1997. Otherwise, the subjects had typical symptoms and physical signs of spinal posterior funiculus damage. However, patients with spinal cord lesion which was caused by other factors were excluded. All accepted subjects provided the confirmed consent. METHODS: Nicolet NT electromyography (EMG)/evoked potential meter (made in the USA) was used to detect spinal cord conduction velocity (SCCV), somatosensory evoked potential (SEP) of lower limbs, motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of extremities. Determining criteria: Measurements were performed based on the laboratory standards. SCCV, which was less than lower limit of normal value (T2–12: 40–55 m/s, T12–L4: 20–41 m/s, T2–L4: 36–45 m/s), was regarded as abnormal. SEP value of lower limbs: P40, P60 and PF, which were more than standard deviation of normal value (x(—)+2.5), were regarded as the abnormality. Normal value of P40, P60 and PF latencies (x(—)±s) in this study: P40, P60 and PF in males were (37.6±1.9) ms, (59.8±3.9) ms and (7.6±0.9) ms, respectively; meanwhile, those in females were (35.5±1.7) ms, (55.2±2.7) ms and (6.3±0.7) ms, respectively. MNCV and SNCV, which were less than 50 m/s in upper limbs and 40 m/s in lower limbs, were regarded as the abnormality. MAIN OUTCOME MEASURES: Electrophysiological examinations. RESULTS: All 4 patients with type 2 diabetes mellitus were involved in the final analysis. ① SCCV: Among 4 patients, SCCV of three patients was decreased in T2–12, T12–L4 and T2–L4, and that of the other one was decreased in T2–12 and T2–L4; however, SCCV in T12–L4 was normal. There was significant difference as compared with normal value (P < 0.01). ② SEP of lower limbs: SEP values of lower limbs were abnormal in all 4 patients. Among them, P40, P60 and PF latencies of two patients were delayed; P40 of one patient was delayed and PF was not drained out; P40 and P60 of the last one were delayed and PF was normal. ③ MNCV and SNCV: The MNCV and SNCV were normal in one patient and abnormal in three patients. The results demonstrated that MNCV and SNCV of extremities decreased; especially, sensory nerve action potential (SNAP) of both lower extremities of one patient were not drained out. CONCLUSION: Detections of SCCV, SEP of lower limbs, MNCV and SNCV of extremities are helpful to investigate whether peripheral nerve and deep sensory passage are damaged or not and determine whether deep sensory damage is caused by peripheral nerve and spinal posterior funiculus.     

Serotonergic projections from the midbrain periaqueductal gray and nucleus raphe dorsalis to the nucleus parafasccicularis of the thalamus

By a double-labeling method combining the retrograde tracing of horseradish peroxidase and the immunocytochemical technique, serotonin-like immunoreactive neurons in the midbrain periaqueductal gray (PAG) and nucleus raphe dorsalis (DR) of the rat were observed to send projection fibers to the nucleus parafascicularis of the thalamus bilaterally with an ipsilateral dominance. These serotonin-containing projecting neurons were observed mainly at the middle-caudal levels of the ventrolateral subdivision of the PAG and less at the middle-rostral levels of the DR.     

Rapidly progressive tabetic neurosyphilis

Since the sexually transmitted diseases were recognizedas a public health problem in China during the early1980's, the incidence of syphilis has graduallyincreased. Though there have been case reports ofclinical variants of neurosyphilis, including syphiliticcerebrospinal meningitis or meningomyelitis andmeningovascular syphilis, occurring in different regions ofChina, ~(1-3) tabes dorsalis or tabetic neurosyphilis has notyet been reported in China. Here, we report a young manwith rapidly progressive tabetic neurosyphilis admitted toour hospital in October 1999.     

La «coxa pedis»

Résumé: La ?coxa pedis? correspond à l'?articulation talo-calcanéo-navicularis?. Structurée comme une énarthrose, il est possible de lui définir une épiphyse représentée par la tête et le col du talus et une cotyle structurée comme une cavité ostéo-fibro-cartilagineuse, à la constitution de laquelle concourent, comme éléments squelettiques, la surface articulaire postérieure du naviculaire et les surfaces articulaires des petites (sustentaculum tali) et grandes apophyses du calcanéus qui forment l'articulation sous-talienne antérieure; parfois divisées entre elles par un sillon, le plus souvent elles constituent une seule formation articulaire. La surface articulaire comprise entre le naviculaire, le sustentaculum tali et la grande apophyse du calcanéus est complétée par un fibro-cartilage gléno?dien renforcé superficiellement par le ligament calcanéo-naviculaire plantaire qui, prenant naissance à la base et sur le contour antéromédial du sustentaculum tali, s'insère distalement sur le tubercule et le bord inféro-postérieur du naviculaire. Ce ligament correspond au fond de la coxa pedis et sous-tend une véritable gléno?de, revêtue de cartilage, en relation articulaire avec le versant inféro-médial de la tête du talus compris entre les versants du naviculaire et du calcaneus. De plus, la présence de corpuscules proprioceptifs dans le ligament calcanéo-naviculaire plantaire fait penser à une fonction réceptrice cybernétique également de la coxa pedis. Aux stades foetaux précoces (16^e-17^e semaine), les articulations talo-naviculaire et sous-talienne antérieure sont différenciées dans une unique structure articulaire présentant des caractéristiques morphologiques d'énarthrose. Dans un sens plus ample, ?coxa pedis? peut définir la signification fonctionnelle particulière d'une structure qui, de par ses données anatomiques, évolutives et cliniques, peut être analogiquement comparée à l'articulation coxo-fémorale avec laquelle, ainsi qu'avec le genou, elle s'intègre fonctionnellement dans la structure plus complexe du membre inférieur. La différenciation énarthrosique proximale et distale au membre inférieur, avec le joint interposé représenté par le genou, est une prémisse biomécanique aux mécanismes de rotation (plan orthogonal aux axes segmentaires du membre) indispensables pour amorcer la stabilisation du membre dans la phase portante (cha?ne cinétique fermée); et, à la succession des mécanismes intercurrents dans le plan frontal (translation latérale de la charge lors du démarrage de la phase portante) et dans le plan sagittal (phase oscillante). Une référence particulière est faite à la pathologie gléno?dienne dégénérative et au syndrome de déstabilisation péritalienne. Récemment, une référence à la ?coxa pedis? (1999) a été faite dans l'édition mise à jour de l'Encyclopédie Médico-Chirurgicale rédigée par Biga, Moulies et Mabit.      

带血管蒂足内侧皮瓣修复足后踝皮肤缺损

目的 报告采用带血管蒂足内侧皮瓣修复踝后侧皮肤缺损的结果。方法 在解剖研究的基础上,根据缺损大小沿足内侧轴线设计皮瓣,首先解剖足底内侧血管神经束,再游离深支的内侧支及伴行静脉,沿舟状骨骨膜及胫后肌腱浅层切取皮瓣。结果 11例皮瓣全部成活,皮瓣面积6cm×6cm-7cm×9cm,随访2-4年,外形及功能恢复满意。结论 带血管蒂足内侧皮瓣薄而柔软,特别适用于修复踝关节后侧的皮肤缺损。     

3例神经梅毒的临床特征分析

目的分析3例神经梅毒的临床特征为早期诊断提供参考。方法回顾性分析3例神经梅毒患者的临床症状、神经影像学和实验室检查特点。结果(1)脑血管梅毒1例,脊髓痨2例;(2)3例血和脑脊液的梅毒抗体均为阳性;脑脊液蛋白含量增加、细胞数增多(以单核细胞为主);(3)脑血管梅毒患者MRA及DSA显示左大脑中动脉M1段闭塞;左大脑前动脉及左大脑后动脉通过皮层支向左大脑中动脉供血区代偿供血;(4)2例脊髓痨患者头颅及胸髓MRI无特殊发现,肌电图及周围神经活检不支持周围神经受损。结论神经梅毒的临床表现与其分型密切相关;首诊易误诊。临床表现及血和脑脊液梅毒抗体阳性是确诊的依据。     

Role of histamine receptor in mesencephalic nucleus dorsalis raphe in cardiovascular regulation

Summary The effects of microinjection of histamine and its antagonists into mesencephalic nucleus dorsalis raphe, were investigated on mean arterial pressure and heart rate in cats to elucidate the nature and role of histaminergic receptors in cardiovascular regulation. Microinjection of histamine (5 and 10 g) into nucleus dorsalis raphe elicited both inhibitory and excitatory cardiovascular responses respectively. On the other hand, microinjection of H₂-receptor blocker, cimetidine (10 g) resulted in hypertension and tachycardia while H₁-receptor antagonist, mepyramine (10 g) microinjection evoked hypotension and bradycardia. Furthermore, local pretreatment with cimetidine and mepyramine blocked the inhibitory and excitatory cardiovascular responses of graded doses of histamine microinjection. These H₁ and H₂ receptors are localized in nucleus dorsalis raphe since microinjection of histamine into adjoining neural structures did not evoke any cardiovascular change. Furthermore, both the inhibitory and excitatory cardiovascular responses to histamine microinjection could not be observed in animals with spinal cord transection and in animals pretreated with p-chlorophenylalanine while they could be observed in bilateral cervical vagotomized animals. Thus, it appears that these cardiovascular responses to microinjection of histamine into nucleus dorsalis raphe, are due to modulation of serotonergic bulbospinal influence on sympathetic preganglionic neurones in the spinal cord. Moreover, the excitatory cardiovascular responses of high dose of histamine (10 g) seem to result from a local release of noradrenaline since they were blocked by prior microinjection of guanethidine and piperoxan into nucleus dorsalis raphe. A release of noradrenaline in turn, modulates the activity of the neurones of the nucleus by acting on adrenoceptors and thereby alters the activity of sympathetic preganglionic neurones. These adrenoceptors appear to be of ₁ type (Saxena et al. 1985, 1987) since phenylephrine microinjection evoked excitatory cardiovascular responses could be blocked by piperoxan. Send offprint requests to K. K. Tangri at the above address     

猫前脑和脑干向中缝背核的纤维投射

中缝背核在针剌镇痛过程中起重要作用。本文用HRP法,对猫前脑和脑干向中缝背核的纤维投射,作了进一步的研究。 HRP注入中缝背核吻侧部后,在前脑双侧先导回皮质和梨状前区皮质V层出现较多被标记的锥体细胞;缰外侧核出现较密集且形态不一的标记细胞;下丘脑各区(视前区、外侧区、内侧区和后区)也出现散在的标记细胞。 HRP注入中缝背核尾侧部后,除前脑出现标记细胞的部位与HRP注入吻侧部者相同外,在脑干中脑导水管周围灰质、蓝斑,其他中缝核(中央上核,中缝线形核和中缝大核)、臂旁内、外侧核及脑干网状结构等处,也观察到标记细胞。结果表明前脑皮质、缰外侧核、下丘脑各区均有纤维直接投射到中缝背核。中缝背核也接受来自中脑水管周围灰质、蓝斑、其他中缝核等核团的纤维投射;中缝背核吻侧部和尾侧部的传入投射,存在一定的局部定位关系,即中缝背核吻侧部只接受来自前脑的纤维投射,其尾侧部既接受来自前脑的纤维投射,也接受来自脑干的纤维投射。