Proximal nerve conduction studies in chronic inflammatory demyelinating polyneuropathy.

OBJECTIVE: The purpose of this study was to evaluate the sensitivity and specificity of proximal upper limb motor nerve conduction study abnormalities in chronic inflammatory demyelinating polyneuropathy (CIDP), using standard percutaneous stimulations up to Erb's point. METHODS: Electrophysiologic data relating to proximal conductions of median and ulnar nerves of 22 patients with CIDP were retrospectively analyzed and compared to those of 22 controls with sensory neuropathy. Distal conduction results were also reviewed. RESULTS: The findings demonstrate independent high sensitivity of abnormal upper limb proximal nerve conduction studies in CIDP. Demonstration of conduction block of >20% and temporal dispersion of >15% had low specificity. However, conduction block was highly specific with cut-off values of >30% at axilla and >50% at Erb's point. Specificity was considerably improved using a cut-off value of >30% at proximal levels for temporal dispersion. Diagnostic sensitivity improved significantly with proximal studies with the criteria used in this population. No adverse effects had occurred as result of proximal stimulations. CONCLUSIONS: Proximal studies are safe, sensitive and reliable procedures in cases of suspected CIDP. Their use appears justified although adequate cut-off values are desirable to optimize their specificity. SIGNIFICANCE: This study indicates that proximal upper limb nerve conductions are appropriate in investigating suspected CIDP, as detailed in recently established electrophysiologic criteria. However, specificity is largely dependent on cut-off values for conduction block and temporal dispersion.     

新生儿皮肤损伤的病因与护理

新生儿皮肤损伤是儿科临床护理的重点和难点,不同原因所致新生儿皮肤损伤护理的侧重点不同.注重新生儿皮肤特点和产生皮肤损伤的原因分析,严格执行操作规程,加强预防措施,提高护理人员责任心,有利于保证治疗效果.     

新生儿皮肤损伤的病因与护理

新生儿皮肤损伤是儿科临床护理的重点和难点,不同原因所致新生儿皮肤损伤护理的侧重点不同.注重新生儿皮肤特点和产生皮肤损伤的原因分析,严格执行操作规程,加强预防措施,提高护理人员责任心,有利于保证治疗效果.     

心理干预对肿瘤深部热疗患者恐惧心理的影响

目的探讨心理干预对肿瘤患者热疗前及热疗过程中恐惧心理的影响。方法将168例行热疗的中晚期恶性肿瘤患者随机分为干预组（96例）和对照组（72例）。对照组行常规治疗护理，干预组治疗前72h及治疗中增加心理干预。结果干预组治疗2个周期后恐惧程度显著轻于对照组（P〈0．01）。结论心理干预可减轻肿瘤患者对热疗的恐惧心理。     

心理干预对肿瘤深部热疗患者恐惧心理的影响

目的探讨心理干预对肿瘤患者热疗前及热疗过程中恐惧心理的影响.方法将168例行热疗的中晚期恶性肿瘤患者随机分为干预组(96例)和对照组(72例),对照组行常规治疗护理,干预组治疗前72 h及治疗中增加心理干预.结果干预组治疗2个周期后恐惧程度显著轻于对照组(P＜0.01).结论心理干预可减轻肿瘤患者对热疗的恐惧心理.     

Correlating extent of neuromuscular instability with acetylcholine receptor antibodies

In a retrospective study of 86 patients with myasthenia gravis (MG), we correlated the acetylcholine receptor (AChR) antibody titers with single‐fiber EMG studies to explore whether a relationship exists between these parameters. We found that the AChR antibody titers correlated significantly with the mean of the mean consecutive difference of orbicularis oculi (OO, P < 0.0001) and extensor digitorum communis (EDC, P < 0.0001). The correlation was found to be stronger in OO. The antibody titers also correlated with the percentage of potential pairs with increased jitter in both muscles and, again, the correlation was more significant in OO (P < 0.0001) than in EDC (P = 0.001). We speculate that this relationship is stronger in OO than in the limb muscles, because the architectural and immunological differences in the motor unit render OO more vulnerable and sensitive to disturbances in neuromuscular transmission. Muscle Nerve, 2009     

Chronic inflammatory demyelinating polyneuropathy-like disorder associated with amyotrophic lateral sclerosis

The association between demyelinating neuropathy and amyotrophic lateral sclerosis (ALS) has been reported rarely. We report four patients who presented with clinical features and investigations suggestive of a neuropathy but who later progressed and received a final diagnosis of ALS according to the original El Escorial criteria. Three patients met the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) 2006 definition for "definite" chronic inflammatory demyelinating polyneuropathy (CIDP), as well as the American Academy of Neurology (AAN) 1991 and Nicolas et al. [2002] electrodiagnostic criteria for CIDP. Two of them showed segmental demyelination on teased-fiber preparations and one had a raised cerebrospinal fluid protein level. Another patient met the Nicolas et al. CIDP criteria and presented with brachial plexus hyperintensity on T2-weighted magnetic resonance imaging, indicative of an inflammatory process. No significant objective response to immunomodulatory treatment was observed in any of these patients who all subsequently progressed unfavorably.