Occurrence of oligoclonal bands in multiple sclerosis and other CNS diseases

The results of cerebrospinal fluid agarose gel electrophoresis in 300 consecutive patients were correlated with neurological examinations and diagnoses, other cerebrospinal fluid studies, and the results of evoked potential examinations. The presence of oligoclonal bands was the most sensitive test for multiple sclerosis (MS); bands were present in from 100% (11/11) of patients with definite MS to 82% (27/33) of those with possible MS (classified by McAlpine criteria). The visual evoked response was the next most sensitive study. Thirty-eight patients without MS or related disorders had bands in the IgG region. Three patients had plasma cell dyscrasias. Seven patients had thick single bands. Single bands did not correlate with chronic polyneuropathy but appeared to be an artifact of storage. Twenty-eight patients had active neurological disease, including cerebral infarction (in 5), viral infection (in 4), remote effect of carcinoma (in 4), and acute and chronic polyneuropathies (in 6). In acute illnesses (i.e., vascular insults), repeat electrophoresis showed disappearance of bands. In continually active disease, bands persisted. These results indicate that the presence of oligoclonal bands provides sensitive supporting evidence for the diagnosis of MS but that bands may be present in other disorders, including those not directly related to infection or abnormal immune response. The data suggest that oligoclonal bands may represent an immune response to neurological injury that is prominent in disorders with a particularly intense or continuous antigenic stimulus.     

Prognosis of ocular myasthenia

A retrospective study of 108 patients with myasthenia gravis who had solely ocular symptoms and signs at onset was carried out to identify factors influencing prognosis. Increasing duration of pure ocular myasthenia was associated with a decreasing risk of late generalized symptoms; only 9 (15%) of the observed generalizations occurred after more than 2 years of solely ocular symptoms. Increasing age at onset was associated with greater risk of respiratory crisis or death caused by myasthenia, whereas patients younger at onset had a greater chance of a benign outcome. Neither systemic curare tests nor responses to repetitive nerve stimulation had prognostic value.     

Sufentanil, a very potent and extremely safe intravenous morphine-like compound in mice, rats and dogs.

Sufentanil (R 30 730), N-[4-methoxymethyl)-1-[2-(2-thienyl)ethyl]-4-piperidinyl]-N-phenylpropanamide, is a chemically novel, highly potent and extremely safe intravenous morphine-like agent in laboratory animals. In mice R 30 730 i.v. is 2304 times more potent than morphine (hot plate ED50's: 0.0028 and 6.45 mg/kg, respectively). The i.v. safety margin of R 30 730 in mice is 1 : 6 679 (LD50 = 18.7 mg/kg). Under the same experimental conditions the safety margin of pethidine is 1 : 7.97, of morphine 1 : 34.9 and of fentanyl 1 : 454. In rats R 30 730 i.v. is 4521 times more potent than morphine (tail withdrawal test ED50's: 0.00071 and 3.21 mg/kg, respectively). The i.v. safety margin of R 30 730 in rats is 1 : 25 211 (LD50 : 17.9 mg/kg). Under the latter experimental conditions the safety margin of pethidine is 1 : 4.80, of morphine 1 : 69.5 and of fentanyl 1 : 277. In dogs R 30 730 i.v. is 2429 times more potent than morphine (apomorphine antagonism test ED50's: 0.00028 and 0.68 mg/kg, respectively). The i.v. safety margin in dogs is approximately 1 : 50 000, the LD50 being +/- 14.0 mg/kg. All morphine-like effects of R 30 730 are immediately antagonized by nalorphine. These pharmacological findings are relevant in connection to the increasing interest for use of morphinomimetics in anesthesia.     

CEPHALIC VASOMOTOR AND HEART RATE MEASURES OE ORIENTING AND DEEENSIVE REELEXES

The problem of differentiating orienting (OR) and defensive reflexes (DR) was investigated by measurements of forehead-skin pulse amplitude (PA), forehead-skin blood content (BC), and heart rate (HR). Thirty male college students received 30 stimulations of .5 sec white noise at either 80 db or 120 db. Beat-by-beat analyses of the physiological measures indicated that both intensities of stimulation produced decreases in PA. Forehead BC showed larger increases to 120 db than to 80 db, and successive stimulations produced a change to overall decreases in BC at both intensities. HR acceleration occurred to both stimuli, and a short-latency deceleration occurred to 80 db. The results were interpreted as showing that cephalic vasoconstriction is the dominant response to auditory stimulation, and cephalic vasomotor responses do not differentiate between ORs and DRs. The short-latency HR deceleration and smaller HR acceleration differentiated the OR from the DR.     

Analytic processing elicits right ear superiority in monaurally presented speech

The latency to respond with the right hand to the initial phone of a monaurally presented CVC syllable is shorter when the stimulus is heard in the right ear than when it is heard in the left ear. This shows that superiority of the left hemisphere can be elicited in simple speech tasks with monaural stimulation. However, the latency to recognize the entire syllable is equally short regardless of ear and responding hand. This is consistent with the view that the left hemisphere is dominant only for tasks that require analysis of the internal structure of a stimulus.     

Troponin I in the diagnosis of acute myocardial infarction in pregnancy,labor, and post partum

Cardiac troponin I has become the marker of choice for the diagnosis of acute myocardial infarction. There are specific characteristics of this test that makes it desirable for the diagnosis of acute myocardial infarction in pregnancy, labor, and post partum.