Pathological complications of non-survivors of newborn extracorporeal membrane oxygenation

The pathology was reviewed of the early deaths identified from the first 50 neonates treated with extracorporeal membrane oxygenation (ECMO) during its introduction to the UK. Fifteen neonates died during or shortly after ECMO between August 1989 and June 1992. Data on 12 are presented (three did not have a postmortem examination). The clinical diagnoses at referral for ECMO were as follows: persistent pulmonary hypertension of the newborn (six infants), primary congenital pneumonia (one infant), community acquired pneumonia (two infants), birth asphyxia (one infant), respiratory distress syndrome (one infant), and meconium aspiration syndrome (one infant). In our group, at necropsy, five had significant haemorrhage (three intracranial, one pulmonary, one pericardial and intraventricular). Three of five infants with evidence of haemorrhage also had signs of sepsis. Six infants had evidence at necropsy of systemic sepsis, five showed evidence of severe anoxic brain injury, and four infants had cerebellar haemorrhages. Three infants had evidence of myocardial ischaemia. It is difficult to discriminate between the relative influence of the primary diagnosis, the mode of treatment, and the severity of presentation in the genesis of this pathology. It is likely that the extent and severity of some of the findings represent a pathological progression that would have been interrupted by the death of the patient, had ECMO not been instituted.     

Serum MBP immunoreactivity and immunoglobulin level as markers of tumour type

Summary Forty three patients, admitted to the department of Neurological Surgery for management of central nervous system tumours, were studied pre-operatively for serum myelin basic protein immunoreactivity as a marker of central nervous system lesion and for circulating immunoglobulins and complement (C₃) levels. Myelin basic protein concentration did not appear to correlate with tumour type or grade. Serum immunoglobulin levels were found to be within the normal range but the mean IgM level was significantly higher in the glioma group when compared with meningiomas.     

Differential response of hypertrophied rat hearts to various α1-adrenoceptor agonists

Summary— With respect to the heart, the prolonged existence of hypertension, both in man and in experimental animals is predominantly characterized by an increase in left ventricular myocardial mass. In this process, the autonomic nervous system plays an important role. Although endogenous catecholamine stimulation of the heart is mainly exerted via the β-adrenoceptors, in several mammalian species, the stimulation of cardiac α-adrenoceptors also mediates positive inotropic actions. We investigated the functional responses of isolated hypertrophied hearts taken from spontaneously hypertensive rats (SHR) and rats with an induced aortic stenosis (ASR) to various α₁-adrenoceptor agonists and compared them with those from age matched Wistar Kyoto (WKY) and "sham" operated controls. Accordingly, we studied the functional response to: methoxamine (α₁), cirazoline (α₁) and phenylephrine (α₁ > β₁). The inotropic response to the α₁-adrenoceptor agonists cirazoline and methoxamine proved to be significantly weaker in hypertrophied hearts from SHR and ASR than in non-hypertrophied hearts from WHY and "sham" operated controls ( p < 0.05). The inotropic response to phenylephrine remained intact in hypertrophied myocardial tissue. However, it was significantly reduced when the hearts were pre-treated with the intracellular Ca²⁺-antagonists ryanodine and TMB-8. These findings show that the mechanism of sarcolemmal Ca²⁺ release, activated by phenylephrine, is still intact in the hypertrophied myocardial cell. In conclusion, these data show that cardiac hypertrophy, be it of genetical or mechanical origin, leads to a reduced response of the isolated heart to α₁-adrenoceptor stimulation.     

Italian multicentre study of carpal tunnel syndrome: study design

In September 1996, during a carpal tunnel syndrome (CTS) symposium, the Italian CTS Study Group was funded. The group designed a strict clinical and neurophysiological protocol for performing a wide multicentre study on idiopathic CTS in hands. In addition to the traditional evaluations, the group also adopted a validated patient-oriented measurement in order to obtain comprehensive and reliable data for the clinical picture. The study was designed to: (1) better assess the clinical picture of the CTS population, especially using new measurement tools (patient-oriented); (2) evaluate the sensitivity of an electrodiagnostic protocol; (3) re-evaluate the validity of a neurophysiological classification; and (4) evaluate the influence of social status and quantify some of the aspects regarding economic and social costs. The study design is described.Participating members of the Italian CTS Study Group: L. Bertin, Padova; T. Carboni, Neurology, Civil Hospital S. Benedetto del Tronto (AP); P.G. Di Pasqua, Neurology, Paediatric Hospital Bambin Gesù, Palidoro (RM); R. Eleopra, Neurology Division, Arcispedale S. Anna, Ferrara; F. Giannini, Institute for Nervous and Mental Diseases, University of Siena; P. Girlanda, Institute of Neurological and Neurosurgical Sciences, University of Messina; M. Giunchedi, Neurophysiology Laboratory, Hospital of Lavagna (GE); A. Grippo, Neurophysiopathology, Civil Hospital, Viareggio (LU); A. Insola, Neurophysiopathology, Orthopaedic Trauma Centre, Rome; R. Liguori, Neurology, University of Bologna; S. Lori, Neurophysiopathology, ASL 10, Florence; R. Lucchetti, Department of Orthopaedics, Traumatology & Hand Surgery, State Hospital, San Marino (RSM); E. Mariani, Neurophysiopathology, Clinical Institute for Specialization, Milano; D. Murasecco, Neurology, University of Perugia; L. Padua, Neurology, Catholic University, Rome; F. Pisano, Neurophysiopathology, S. Maugeri Foundation IRCCS, Veruno (NO); M. Romano, Neurophysiopathology, Villa Sofia CTO, Palermo; C. Speranzini, Neurology, Hospital A. Murri, Fermo (AP); E Tironi, Neurophysiopathology, Ospedali Riuniti, Bergamo; A. Uncini, Regional Centre for Neuromuscular Diseases, Hospital SS Annunziata, Chieti     

Clinical Assessment of Gestational Age

There is disagreement among authors as to what criteria are most reliable in assessing postnatal fetal age. A comparison–for objectivity, accuracy, and frequency of use– of specific criteria was made using three independent examiners at different educational levels: a second-year medical student, a perinatal nurse practitioner, and a pediatrics resident. It was shown that trained examiners develop favorite criteria which differ among examiners and thus sacrifice accuracy; however, accurate assessment of fetal age can be accomplished by an examiner with minimum clinical knowledge.     

Development of an improved multi-pressure-sensor probe for recording muscle contraction in human intestine

We have developed an improved semiconductor recording probe for monitoring motility of the upper small intestine in humans. The probe consists of six ultraminiature silicon pressure sensors spaced 10 cm apart and encased in a flexible polyurethane sheath. The probe is small [2.67 mm (8F) diameter], is easily passed transnasally, and is tolerated by patients for prolonged recording periods (24–36 hr) with a minimum of discomfort. The initial semiconductor and catheter material were those designed for use in the cardiovascular system, but they proved to be easily damaged by gastric acid and enzymes. After improvement of this probe, we now have recordings from more than 100 patients for an approximate total of 6000 hr of recording time. The improved probe is a durable recording device that facilitates the investigation of motility of the small intestine in humans in health and disease.This study was supported by funds from the Medical Research Service of the Veterans Administration and by National Institutes of Health Clinical Research Center grant RR-82.     

Functional obstructive hydrocephalus

Summary Personal observations are presented on two patients with normalpressure hydrocephalus and elongated basilar arteries. Although the elongated basilar artery in neither case indented the floor of the third ventricle, no other possible cause of the communicating hydrocephalus could be found, and it is suggested that it may have originated by a purely functional mechanism.

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Obstruktiv funktioneller Hydrocephalus

Zusammenfassung Die Autoren stellen ihre Beobachtungen über zwei Patienten dar, die einen Hydrocephalus mit normalem Druck und eine Verlängerung der basilaren Arterie zeigten. Auch wenn die basiläre Arterie am Boden des dritten Ventrikels keine Spur hinterließ, und da jede andere aetiopathogenetische Ursache zu vermissen war, nehmen die Autoren an, daß der obengenannte Hydrocephalus rein funktionelle Ursachen haben kann.

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Hydrocéphalie obstructive fonctionnelle

Résumé Les auteurs décrivent leurs observation à propos de deux malades qui présentaient une hydrocéphalie à pression normale. Bien que l'allongement de l'artère basilaire ne modifiait en rien le plancher du IIIe ventricule et qu'aucune autre cause pathogène ne put être relevée, les auteurs mettent l'hydrocéphalie communicante en rapport avec des mécanismes exclusivement fonctionnels.

     

Neuromuscular block after intra-arterially injected acetylcholine: 1. Introduction, methods, and technique

The neuromuscular depolarizing block induced by intra-arterially injected ACh was studied to determine the variability in the same subject and in different subjects without disorders at the motor end-plate. Amplitude of action potentials of the opponens pollicis muscle evoked by intermittent repetitive supramaximal stimulation of the median nerve at the wrist were recorded for one hour from the beginning of ACh injection. The features of prompt and late depression stages after the injection were analysed statistically. Re-testing of the same subjects after a while shows that, in spite of all efforts to maintain the same experimental conditions, variations do occur in late depression. Time course and duration are particularly affected, while the degree of depression is altered but slightly. The presence of such variations limits this test to evaluation of the influence of other factors only within their already established statistical limits.