Femoral nerve involvement in diabetics

Background and purpose:  In this study, the conduction of the femoral nerve has been evaluated in diabetic patients without clinical signs of femoral nerve involvement and in a group of healthy subjects.
Methods:  Forty-eight patients have been included in the study. Patients have been examined in terms of neuropathy and their neuropathy scores have been calculated. In addition to the nerve conduction studies have been performed. The findings of the diabetic patients have been compared with those of the 26 healthy volunteers.
Results:  There has been a statistically significant difference between diabetics and the healthy volunteers in the control group in terms of both femoral nerve motor latency and amplitude. The femoral latencies of patients have significantly been related to the total neuropathy score. A significant difference between diabetic patients without polyneuropathy and the controls was observed with respect to their femoral latencies.
Conclusion:  In our study, femoral nerve conduction abnormalities have been determined in diabetics who clinically did not have femoral nerve involvement. It has been observed that these abnormalities become more evident as the polyneuropathy of the patients becomes more serious. Our study has shown that femoral nerve conductions may increase the sensitivity of the diagnosis of polyneuropathy.     

Electrophysiological evaluation of central and peripheral neural effects of lead exposure

Lead encephalopathy is more usual in children and has rarely been observed in adults. Peripheral neuropathy on the other hand is of more common occurrence among adults with occupational lead exposure, and has been extensively studied with electrophysiological methods. Although encephalopathy often manifests itself with generalized seizures, usual electroencephalographic (EEG) findings have been diffuse slow wave abnormalities. Paroxysmal abnormalities either focal or generalized spikes and/or sharp waves have been detected in some patients. Evoked potential studies have lately been applied to children or adults with a relatively low level of lead exposure, and minor dose-dependent differences have appeared in comparison to control groups. Subclinical signs of peripheral neuropathy have been detected among human subjects with various levels of lead exposure. Nerve conduction velocities of lead workers have been generally lower, although the means have been within normal limits. Some authors have shown clear correlations between measures of lead exposure and nerve conduction velocities indicating an exposure--effect relationship.     

Neuroblastoma and fetal exposure to phenytoin in a child without dysmorphic features.

Despite the fact that the teratogenic effects of phenytoin have been suggested in several case reports, the evidence for a possible oncogenic potential of phenytoin has not been widely recognized. Recently, neuroblastoma as well as other neuroectodermal and non-ectodermal tumors has been seen in several children exposed to phenytoin prenatally. Previous cases have been almost uniformly associated with the features of "fetal hydantoin syndrome" and none have been developmentally normal. We report a developmentally-normal boy of 21/2 years with an abdominal neuroblastoma whose mother had been on phenytoin (as well as carbamazepine) throughout gestation. We review the various neoplasms which have been reported in the offspring of mothers receiving phenytoin.     

Autism: review of neurochemical investigation.

The neurochemistry of autism, the most well-validated childhood neuropsychiatric disorder, has been studied extensively over the past three decades. Autism is of interest neurochemically because it represents a relatively homogeneous disorder with a triad of social, communicative, and intellectual developmental disturbance. Because a sufficient animal model has been lacking and relatively few diagnosed people with autism have died, most investigation has been of peripheral fluids and tissues. The most consistent finding has been that over 25% of autistic children and adolescents are hyperserotonemic. However, after 29 years of investigation, the mechanism of hyperserotonemia has not been determined. Hyperserotonemia has been found to be familial. Elevated plasma norepinephrine has also been a replicated finding. Cerebrospinal fluid (CSF) opiate activity has been found to be elevated in two studies. Plasma cyclic adenosine monophosphate (cAMP) has been found to be elevated in autistic children. A high rate of nonsuppression after dexamethasone and blunted or delayed growth hormone response to L-dopa have been found. Abnormal cell-mediated immunity has been replicated consistently in autism. Although several pharmacological trials have been conducted and shown promise in initial open trials, only "typical" antipsychotic drugs have shown replicable chronic ameliorating effects in double-blind trials. However, chronic neurotoxicity (tardive dyskinesia) has also been revealed. Findings of morphological changes in the cerebellum have been replicated. Findings in need of replication include diminished platelet function, increased baseline CSF homovanillic acid, decreased nerve cell adhesion molecule serum fragment, blunted prolactin response to fenfluramine, amelioration of symptoms by naltrexone and bromocriptine, reduced electroretinographic (ERG) b-wave amplitude, and morphological changes in the hippocampus, amygdala, and septal nuclei. In addition to refining and replicating past findings, future directions that may be fruitful include investigation of neurochemical aspects of platelet function, of interactions between monoaminergic systems, of phosphatidylinositides, and of pharmacological response to "atypical" antipsychotic agents and relatively selective serotonin receptor subtype agonists or antagonists.     

Semen retrieval in spinal cord injured men.

A fertility programme for spinal cord injured men has been in progress for nearly 5 years. Thirty eight men have been treated in this programme. Electroejaculation, vibration ejaculation and subcutaneous physostigmine have all been used successfully to obtain semen. Semen has been obtained from 21 of 24 men with a lesion at T8 or above, and from 4 of 11 men with lesions below T10. There have been 8 pregnancies from 6 couples.     

Disseminated choroid plexus papillomas in adults: A case series and review of the literature

Choroid plexus papillomas (CPPs) are uncommon, usually intraventricular, low-grade tumors, accounting for less than 1% of all intracranial neoplasms and 2–4% of brain tumors in children. Dissemination of CPPs to multiple levels of the neuraxis has been seldom observed. Thus far, only 26 adult patients have been reported in the English language literature. With some exceptions, disseminated CPPs have been observed in adults and involved multiple sites along the cerebrospinal fluid pathways. Occasionally, intraparenchymal extension has been documented, and secondary involvement of the suprasellar region has been reported in only five patients. Postoperative treatment of CPPs has not been standardized. Most recommended therapies have been extrapolated from a series of atypical papillomas or carcinomas of the choroid plexus in children. We herein report a series of three patients of disseminated choroid plexus papillomas providing additional insights into this relatively rare entity.     

Cardiovascular disease and sleep-related erections

Sexual difficulties are highly prevalent in male patients with cardiovascular diseases, such as hypertension, atherosclerosis, and hypercholesterolemia. Recently, several studies have been conducted on the effects of cardiovascular diseases, as well as associated drug and nondrug treatments, on nocturnal penile tumescence (NPT) and other measures of sexual function. Although an overall trend has been observed toward decreased NPT in patients with chronic hypertension and other cardiovascular conditions, design and methodological difficulties have been noted in most studies, and results have been generally inconclusive. Similarly, antihypertensive drugs such as beta-blockers and diuretics have been associated with diminished NPT in several studies, although methodological problems have again been noted. Furthermore, the mechanism of action of antihypertensive drugs on sleep-related erections has not been determined. Most recently, a positive effect of cholesterol-lowering drugs (pravastatin, lovastatin) on NPT has been observed in middle-aged males with chronic hypercholesterolemia. Additional studies of the effects of cardiovascular disease on NPT and other measures of sexual function are needed.     

Flexor reflex afferent nerve fibres in man

Flexor reflex afferent nerve fibres have been identified in the mixed peripheral nerve and measurement of their conduction velocity has been carried out. It has been demonstrated that the flexor reflex afferent fibres have a higher threshold of stimulation than the motor fibres supplying the foot muscles. The effect of conditioning volleys in the flexor reflex afferent fibres on the H reflex has been determined and reciprocal inhibition of extensor motoneurones has been found to be related to the second component of the flexor reflex.     

Neurological soft signs in schizophrenia

Neurological Soft Signs (NSS) are defined as potential biological markers for schizophrenic disorders. There has recently been a renewer interest in its study. These NSS are not related to localized brain lesions, but it has been hypothesized that they reflect abnormalities in motor, sensory and integrative functions. It has been reported that schizophrenic patients exhibit NSS years before of the onset of psychotic symptoms and that they remain after recovery of that symptoms. Environmental and genetic causes have been involved in their origin. Different assessment scales have been developed in order to allow for comparisons between different studies and for relating NSS to clinical, psychopathological, neurocognitive, social and demographical variables of the disease. It has been demonstrated their relative independence of treatment and evolution of the disease.     

ANTIEPILEPTIC DRUG CONCENTRATIONS IN PLASMA: Clinical Evaluation of 321 Estimations in 237 Unselected Patients

Two chromatographic methods of estimating plasma concentrations of antiepileptic drugs, designed by the authors and described elsewhere, have been used to examine 321 samples of plasma. The methods have been shown to be simple and to fit satisfactorily into a busy laboratory programme. Results obtained with both methods have been found to agree with those of other workers who used a wide variety of techniques. Ranges of plasma concentrations of four commonly-used drugs have been established. Plasma concentrations do not correlate well with drug doses in individual patients. Negligible plasma concentrations have been found in some patients. Possible metabolic interactions have been revealed.     

Interventions to alleviate patients' stress: A review

Many events occuring in hospital have been found to be stressful for patients. Interventions aimed at alleviating these reactions have, in the main, been evaluated by psychologists and nurses. Methods used and contrasting approaches are reviewed. Although surgery has been the main event for this research, special investigations, treatments and hospital admission and discharge have also been studied. Outcome criteria have varied with physical measures being used more by nurses. Emphasis has been placed on preventing complications rather than enhancing recovery. Recent work has tended to compare types of intervention. Focused positive reappraisal and information on sensations are provided rather than procedural details as they have been found more successful in alleviating stress.     

Psychiatry and chronic pain

Pain and chronic pain have been defined by the International Association for the Study of Pain. Psychological mechanisms are recognized in the production of pain, but their importance has probably been overstated. Selection factors have not been attended to sufficiently, and traditional methods which have been relied upon for the diagnosis of hysterical pain have been misleading. Much emotional change seen with pain is a consequence of the physical disorder. Types of illness, seen by psychiatrists working with patients in pain, are described, and brief comments offered on their management.     

Cell adhesion molecules in neural development

Adhesive mechanisms have been implicated in several morphogenetic processes during development. In the last decade several molecules mediating specific adhesion between cells and between cells and their environment have been characterized. Possible roles in morphogenesis have been established for some of these molecules. In the brain, four cell-cell adhesion molecules have been characterized: NCAM, L1, the myelin-associated glycoprotein and N-cadherin. Furthermore, a cell-substrate adhesion molecule, cytotactin, and its proteoglycan ligand have been described. We here review the data on structure, localization, developmental regulation and function of these molecules in brain.     

Psychiatric and Behavioural Disorders in Children with Epilepsy (ILAE Task Force Report): Epilepsy and psychosis in children and teenagers

Psychosis related to epilepsy or antiepileptic treatment can occur in teenagers and very rarely in children. Postictal, interictal and antiepileptic‐drug‐induced psychosis have all been reported in young people. Whether ictal psychosis occurs in this age group remains open to debate. Neuronal antibody encephalitis such as anti‐NMDA receptor encephalitis can present with seizures and psychosis, both of which can resolve with prompt, appropriate immunotherapy. In addition, there have been several reports in which the terms psychosis or psychotic features have been used loosely to describe behavioural disturbance in children with epilepsy; in these cases there have apparently been no diagnostic features of psychosis, implying that these terms should not have been used. The management of epilepsy‐related psychosis in young people is similar to that in adults. Antipsychotic medication should not be withheld if it is needed on clinical grounds. If the psychosis has been induced by antiepileptic medication then a medication review is necessary.     

EEG in migraine: a review of the literature

EEG abnormalities in migraine have been reported by a number of authors during the last 50 years. Prevalences vary considerably in the older literature. A number of unspecific rhythms related to drowsiness or hyperventilation have probably been counted as "abnormal", and the reported numbers of definitely abnormal EEG rhythms have been consistently low. In a few controlled and blinded studies, however, slight excess of various EEG rhythms has been found in migraine patients. Similar prevalences of interictal EEG abnormalities have generally been found in patients with classic and common migraine, but the diagnostic classification may not have been precise enough in some studies. During visual aura, either slow waves, depression of background activity amplitude or normal EEG have been reported. The most definitely abnormal EEGs with unilateral or bilateral delta activity have been recorded during attacks of hemiplegic migraine, and during attacks of migraine with disturbed consciousness. The relationship between migraine and epilepsy has still not been adequately clarified. The connection seems to exist in several small entities (e.g. migraine-like headache as an epileptic manifestation, epileptic seizures triggered by epileptic attacks, and possibly in epilepsies with occipital spike waves), but it is seemingly not "fundamental". Newer methods, i.e. EEG frequency analysis and topographic brain mapping, are promising tools in this field. So far, mostly small studies have been published with somewhat inconsistent results. A pattern of increased alpha rhythm variability (and/or asymmetry) in the headache-free phase seems to emerge, however. Significant asymmetry of alpha and theta during headache has been reported in one topographic brain mapping study. Magnetoencephalographic studies of migraine patients have demonstrated slow wave-shifts (similar to those observed in animals with spreading depression). The EEG patterns observed in migraine patients seem to suggest a possible physiological connection between sleep, hyperventilation and migraine. The study of such relationship may shed new light on migraine pathophysiology.     

Adolescent female with withdrawal psychosis following abrupt termination of ziprasidone

It is widely known that discontinuation reactions can occur after neuroleptics are stopped resulting in dyskinesia through its effect on the nigrostriatal pathway. Less discussed is the concept of “supersensitivity psychosis” which has been described as a rapid onset of psychosis after a neuroleptic medication has been withdrawn. Although the concept of supersensitivity psychosis has been described with the discontinuation of some neuroleptics, it has not been described with ziprasidone. Furthermore, the following case report is the first time that this phenomenon has been described in an adolescent patient who has discontinued ziprasidone. Reasons for supersensitivity psychosis are explored in addition to suggestions about precautions about prescribing neuroleptics in young people.     

The human blink reflex

A detailed study of the human blink reflex in the different parts of the orbicularis oculi muscle has been carried out. The first component of the blink reflex has been demonstrated in patients with Friedreich's ataxia, who have selective loss of large sensory fibres resulting in loss of proprioceptive input. It has been established that both components of the blink reflex are cutaneous reflexes which represent a highly organized and purposeful mechanism in man. Afferent fibres for the blink reflex have been identified in the human supraorbital nerve and their conduction velocity has been estimated for the first time in man. It has been demonstrated that both components of the blink reflex are mediated by the same group of afferent fibres.     

A review of the depressive personality

A depressive type of personality disorder has been described by both German phenomenologists and psychoanalysts and has been used by clinicians for years. Although this personality type has been included in standard international nosologic systems (ICD-9), it has never been recognized in DSM. This literature review identifies and explores the issues relevant to the possible inclusion of such a category--an axis II personality disorder linked to axis I depressive disorder--in the upcoming DSM-IV.     

Methods in dose response platelet aggregometry

A standardized method for performing dose response platelet aggregation has been developed, and has been used in about 1000 subjects in a large prospective study of ischaemic heart disease. A computer program has been used to fit a sigmoidal relationship between primary aggregation response rate and the log dose of aggregating reagent. Estimates of the parameters of the sigmoid curve are used to characterize an individual's platelet aggregability. Methods for investigating the maintenance of long-term quality control have also been developed.     

Micro-tremor of the eyes of comatose patients.

An electronic method has been used to record the micro-tremor of the eyes of a group of comatose patients. Changes in the micro-tremor waveform patterns have been observed in successive records taken over a period of several days. These changes have been associated with changes in the depth of coma.