Continuous multivariable monitoring in neurological intensive care patients-preliminary reports on four cases

Evoked potential monitoring is a standard examination method in neurological intensive therapy units. Previously, multimodality observation was only possible in follow-up examinations. First experience with a new bed-side system continuously monitoring 12 neurophysiological and clinical parameters is reported. It consists of a personal computer and various stimulation units. EEG activity, median nerve somatosensory evoked potentials (SEPs) and brainstem auditory evoked potentials (BAEPs) are recorded. Additionally, EEG spectral band power, heart rate, heart rate variability, intracranial presure, body temperature, expiratory PCO₂, blood pressure and transcutaneously measured oxygenation can be monitored. This paper reports on 4 exemplary cases of the 33 patients we have monitored to date, illustrating the principles and main advantages of the system. The system was developed to support the observation of ICU patients as well as to aid therapeutic decisions. It supports the clinical determination of brain death by specifying the deterioration of various neurological systems.Supported by the Fonds zur Förderung der wissenschaftlichen Forschung, project S49/03 and the Ministry of Science and Research, Austria     

Mydocalm treatment of muscular and vascular complaints accompanying climacterics.

Coated Mydocalm tablet, known as striated muscle relaxant and peripheral vasodilator, has been used in climacteric women. The women suffered from muscular and vascular complaints besides the common symptoms of decreased or lacking ovarian function which could not be controlled with oestrogen substitution therapy. Mydocalm significantly moderated these complaints without causing unwanted effects and the majority of the women could be maintained in a complaint-free condition in this respect. According to the opinion of the author the drug is a valuable adjuvant to an adequate hormone therapy.     

Diagnosis and treatment of status epilepticus on a neurological intensive care unit

Status epilepticus refractory to first-line therapy is associated with a high morbidity and mortality. Correct diagnosis and adequate treatment of this condition require electrographic monitoring and anaesthetic facilities available in specialist intensive care units (ICUs). We carried out an audit of 26 patients admitted to a neurological ICU with a diagnosis of status epilepticus, to identify deficiencies in diagnosis and management prior to transfer to the ICU, and examine the effectiveness of ICU management. Or transfer, only 14 (54%) were in status epilepticus; six were in drug-induced coma or were encephalopathic, and six had pseudostatus epilepticus, of whom four had been intubated. The commonest treatments prior to transfer were benzodiazepines, chlormethiazole and phenytoin; the loading dose of phenytoin was adequate in at least 7/16 cases. All those in status epilepticus on transfer had their seizures successfully controlled, but ten required general anaesthesia with thiopentone, propofol, ketamine or midazolam. Two died--one had a severe encephalitis and the other had had a cardiac arrest prior to treatment. This study highlights deficiencies in the initial diagnosis and management of status epilepticus, the role of specialist neurological intensive care, and the importance of early referral.      

Observations with Norcuron in general surgery cases

Norcuron, a neuromuscular blocking agent of medium duration of action has been applied to 50 general surgery patients. The muscle relaxant assured the muscle relaxation required for performing operations of 25'-180' duration, if required by repeating the drug administration. The drug had no cardiovascular side-effects. It's action could be easily and rapidly antagonized. In spite of the relative overdosage used by the author unexpected phenomenon did not occur and the unwanted effects of Norcuron did not develop. The product is a myorelaxant which may be safely and flexibly used and the doses of which may be easily changed.     

High-dose Mydocalm therapy in certain myogenous headaches

Oral Mydocalm intermittent therapy was used in 113 patients suffering from myogenous cephalalgia. Daily 3 +/- 150 mg tolperisonum doses relieved, within 3-7 days, spasm, hypertonicity, rigidity of occipital, cervical, and shoulder muscles, and resulted in functional improvement and successfully controlled myogenous cephalalgias.     

血浆置换在神经系统疾病中的应用

目的回顾分析血浆置换（plasma exchange,PE）治疗神经免疫性疾病患者的资料,了解其疗效和不良反应。方法对78 例应用PE 换治疗过的患者资料回顾性分析,其中包括73 例重症肌无力（myasthenia gravis,MG）,3 例吉兰巴雷综合征（Guillain-Barre′syndrome,GBS）,1例慢性炎性脱髓鞘性多神经根神经病（chronic inflammatory demyelinating polyneuropathy, CIDP）和1 例多发性硬化（multiple sclerosis,MS）。PE 头3 次为隔日1 次,之后为隔周1 次,偶有1周2 次。应用临床评分观察疗效,根据临床记录了解有关副反应。结果 73 例MG 患者PE 后第3d、第14d和第30d临床绝对评分明显降低,差异具有统计学意义。PE对3例GBS和1例CIDP患者疗效肯定,1例MS患者行双重置换（double filtration plasmapheresis,therapy, DFPP）后临床症状改善不明显,以上患者在PE 治疗过程中未见严重不良反应。结论 PE 在多数神经系统免疫疾病如MG、GBS 和CIDP 疗效肯定,不良反应较少。在治疗中枢神经系统脱髓鞘病（例如MS等）的情况有待进一步观察。     

Several years observations with Mydocalm muscle relaxant in locomotor disease patients.

Two therapeutic methods were compared on locomotor disease patients; the currently used anti-inflammatory complex therapy and the same therapy complemented with Mydocalm. On the basis of the changes of pain indices and motion indices chosen as parameters it could be concluded that Mydocalm is a valuable adjuvant, especially in improving locomotor functions, and it promotes the improvement of the general condition of the patients and the performance of their daily activities by relieving muscular hypertonia and contractures.     

Clinical experiences with a variable balanced diet in a neurological intensive care station]

The variable balanced diet (Berodi?t V) consisting of only a few requirement-adapted components can be used for longterm tube feeding in many patients of a neurological intensive care unit. This extraordinarily high energy supply necessary in this group of patients can be accomplished without difficulties, which makes it possible to dispense with longterm parenteral feeding. Preparation and administration are unproblematic. Cases of intolerance were observed only, if the rate of administration was too high.