Microbleeds in dementia with Lewy bodies

Journal of Neurology - Microbleeds are associated with the development of dementia in older people and are common in Alzheimer’s disease (AD). Their prevalence and clinical importance in...     

Transanal total mesorectal excision achieves equivalent oncologic resection compared to laparoscopic approach,but with functional consequences

BackgroundThis study compared transanal total mesorectal excision (taTME) to laparoscopic total mesorectal excision (laTME) for the treatment of low rectal cancer. Adequacy of oncologic resection as well as postoperative outcomes were analyzed.MethodsWe retrospectively reviewed all proctectomy for low rectal cancer by a single surgeon at our institution from January 2014 to September 2019.ResultsThere were 20 taTME and 30 laTME patients. TaTME patients had more distal tumors with no difference in pathologic resection margins or frequency of positive distal margin. Operative times were longer for taTME, but there were no differences in short-term outcomes or complications. TaTME patients had a higher rate of postoperative fecal incontinence.ConclusionTaTME may be a good option for the most distal tumors, when distal margins may be compromised. TaTME provides equivalent oncologic resection, but there is a higher incidence of postoperative fecal incontinence.     

Microsurgery as an aid to middle cerebral artery endarterectomy.

1. Instrumentation and technique for microsurgical reconstruction of small arteries are described. 2. Two cases are reported in each of which an obstruction was removed from the middle cerebral artery for early hemiplegia. 3. The work presented is of a preliminary nature. No conclusions can be drawn as to ultimate value. Further clinical trial seems justified.     

Progressive sensory nerve dysfunction in amyotrophic lateral sclerosis: a prospective clinical and neurophysiological study

Sensory nerve function was determined in 19 patients with amyotrophie lateral sclerosis (ALS), using a battery of clinical and neurophysiological tests. This assessment was repeated on 12 patients after intervals of 6–18 months. Twelve controls were also studied. In the ALS group, only 2 patients had noticed mild sensory symptoms and none had sensory signs. Between successive studies the vibration thresholds increased, but not to a significant degree. ALS patients showed a significant fall in amplitude of the sensory nerve action potentials in the median, radial, and sural nerves (P < 0.04); sensory nerve conduction velocity did not alter. The median nerve somatosensory evoked potential N19 latency showed a highly significant increase (P < 0.008). Significant subclinical deterioration in sensory nerve function occurs in ALS, and parallels the progressive motor decline. Neuronal degeneration in ALS is not restricted to motor neurons.     

Generalized peripheral neuropathy in a dental technician exposed to methyl methacrylate monomer.

A 58-year-old dental prosthetic technician developed generalized sensorimotor peripheral neuropathy. Neurophysiologic studies showed a generalized sensorimotor neuropathy of axonal degeneration type. Examination of a sural nerve biopsy showed a moderately severe axonal neuropathy with loss of large myelinated fibers and unmyelinated axons. There was evidence of slow ongoing degeneration and considerable fiber regeneration. Electron microscopy showed increased numbers of filaments in a few fibers. These findings show resemblances to the nerve changes caused by another acrylic resin, acrylamide. We suggest that the neuropathy may have been caused by 30 years of occupational cutaneous and inhalational exposure to methyl methacrylate monomer since we excluded other recognized causes of neuropathy.