Median nerve somatosensory evoked potentials in migraine

In visual evoked potential studies, habituation during stimulus repetition with the same stimulus at a constant intensity has been found to be abnormal in migraineurs between attacks. The purpose of this study was to investigate habituation of somatosensory evoked potentials (SEPs) and the effects of migraine on them. Eighty-five subjects were included in the study: 30 healthy volunteers (HVs) and 55 migraineurs [30 with migraine without aura (MO), 25 with migraine with aura (MA)]. During continuous stimulation at 3 Hz, four blocks of 100 responses were sequentially averaged of Erb's point (N9), cervical (N13), and cortical (N20) median nerve SEPs. Mean amplitude changes in the second, third and fourth blocks are expressed as percentages of the first block. There was habituation to N13 and N20 in the second, third and fourth blocks in HVs. In the migraine groups, there was no habituation; on the contrary, potentiation was found. This potentiation was statistically significant only in the second blocks for N13 (MO P=0.007, MA P=0.01 versus HVs). However, in both migraineur groups, the rate of N20 potentiations was statistically significant versus that in HVs for all blocks (all P < 0.05). It is concluded that whilst physiological habituation occurs in HVs for cervical and cortical SEPs, in migraine patients there is an interictal deficit of habituation of this sensory modality.     

Haemostatic effect of Ankaferd Blood Stopper(?) seen during adenoidectomy

In Turkey, Ankaferd Blood Stopper(?) (ABS) has been approved for the management of external haemorrhages and bleedings occurring during dental surgeries (Goker et al., 2008). Ankaferd comprises a standardized mixture of plants, including Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica diodica. This study aimed to evaluate the efficacy of AB S tam ponade in the control of intra-operative bleeding occurring during ad enoidectomy performed in children under the age of 12. Sixty children were randomized to receive 1 to 5 minute-tamponade with either ABS or topical gauze sponges soaked in saline solution (SS) during their ad enoidectomy.. Time-to-haemostasis and the number of packs required were recorded. A visual analog scale was used by the operating surgeon to record subjective data, including the rate of bleeding following the first adenoid pack removal (0= none, 3=brisk). Compared to the children in the SS group (n=30), time-to-haemostasis seen in ABS patients (n=30) was significantly shorter (mean ± standard deviation, 1.93 ± 1.39 min vs 3.20 ± 1.50 min; p<0.0001); they required a lower number of packs (mean, 1.93 vs. 3.20), and appeared to bleed less (53.3% vs 6.7%; p=0.0001). ABS aids in the control of intra-operative bleeding and reduces the number of packs required to achieve haemostasis, so that it can be recommended for tamponades per formed during paediatric adenoidectomies.     

Significance of atypical triphasic waves for diagnosing nonconvulsive status epilepticus

The aim of the study described here was to analyze findings in 15 cases who were admitted with nonconvulsive status epilepticus (NCSE) and whose EEGs featured atypical triphasic waves (ATWs). We also investigated whether ATWs are useful for diagnosing this condition. Mental status was assessed, and EEGs were recorded during/after the antiepileptic drug treatment. Eight patients had metabolic disorders and nine had intracranial pathology. The ATWs were unilateral focal in 5 cases and bilaterally asymmetrical focal in 10 cases. In 11 of the 15 cases, the ATWs disappeared and mental status improved after treatment. NCSE should be considered in any individual who presents in an acute confusional state and whose EEG reveals either unilateral or bilaterally asymmetric ATWs.     

Spinal cavernous malformations: a report of 5 cases

BACKGROUND: This is a report of 5 patients treated surgically for SCMs. METHODS: During the period from 1998 to 2003, 5 patients (4 male and 1 female) harboring SCMs were treated surgically (all of them underwent complete surgical removal). Patients' ages ranged between 22 and 57 years (mean age, 46 years). Median duration of symptoms was 31 months (1-120 months). Diagnosis was made by MRI scan showing lesions in length of 1 to 6 cm in diameter (mean length, 2.9 cm). Three lesions were found in the cervical, one in the upper dorsal, and one in the lower dorsal cord. One of them was located extradurally, one of them intradural extramedullary, and 3 of them intramedullary. RESULTS: An MRI examination showing total removal was performed postoperatively in each patient (the postoperative MRI examinations revealed total removal in all cases). The follow-up period ranged from 1 to 4 years (mean, 27 months). All patients showed clinical improvement, with 3 of them worsening early in the postoperative period but doing better in long-term follow-up (although 3 of 5 patients had worse neurological examinations in the early postoperative period, all recovered in long-term follow-up and clinically improved relative to preoperative status). CONCLUSION: Neurological status of the patients can worsen in the early postoperative period, causing intramedullary operation; but it usually improves relative to preoperative status. Surgical removal seems to be a safe and a promising way of treatment of symptomatic SCMs.     

Interpositional arthroplasty with extensor digitorum brevis tendon in Freiberg's disease: a new surgical technique

BACKGROUND: Freiberg's infraction is an osteochondrosis of a lesser metatarsal head resulting in joint degeneration. There is no consensus regarding the management of these lesions. Here, we describe an interpositional arthroplasty using extensor digitorum brevis tendon as a solution for Freiberg's disease. MATERIALS AND METHODS: Between 2003 and 2006, 6 women and 4 men with Freiberg's disease unresponsive to conservative treatment were operated with interpositional arthroplasty with extensor digitorum brevis tendon. Mean age was 34 (range, 20 to 48) years and followup time 24.6 (range, 12 to 36) months. The transferred tendon was passed through a tunnel, centered, stabilized and rolled into a ball following the debridement of joint. According to the Smillie classification, there were 3 grade II, 5 grade III, and 2 grade IV. The AOFAS scoring system was used for clinical assesment. RESULTS: The mean preoperative and postoperative AOFAS scores were 58.3 (range, 44 to 77) and 80.4 (range, 67 to 100), respectively. The complaint of pain with joint motion was decreased in all patients except one. The postoperative passive range of motion of joints did not differ significantly. We found 4 excellent (40%), 5 good (50%) and 1 poor (10%) result. CONCLUSION: We recommend our technique of interpositional arthroplasty with the extensor digitorum brevis tendon because it is free of additional donor site morbidity. It can be performed easily without specialized instruments. Also, the use of natural tissue eliminates potential foreign body reactions and risk of infection.     

Thymoma with chronic diarrhea

Thymoma associated with hypogammaglobulinemia and profound susceptibility to recurrent and serious infections was first reported by Good in 1954, after whom it was named as Good's syndrome. Chronic diarrhea associated with thymoma is almost always seen in patients with hypogammaglobulinemia. However, chronic diarrhea in a setting of normal gammaglobulins have been rarely reported. We hereby report two cases of thymoma with normal immune functions, presenting with chronic diarrhea as the only symptom of thymic malignancy. We discussed the etiopathogenic relation between thymic pathology and diarrhea and review the cases of thymoma associated with chronic diarrhea in the English literature.     

Reversible valproate-induced choreiform movements.

Valproate is an anticonvulsive drug whose mechanism of action is based on GABAergic systems. One of the infrequent adverse effects of valproate is choreiform movements. In our study, we report a patient having head trauma history with partial and secondary generalized seizures taking 1500 mg/day valproate. During the second month of the therapy, generalized chorea was observed. Since other aetiologic causes of chorea were excluded, acutely occurring chorea in the patient was thought to be related with valproate usage because of persistence of choreiform movements for days without any fluctuation. Valproate was stopped slowly and lamotrigine was added at a dose of 400 mg/day. Within a two-month period after cessation of the valproate, choreiform movements had disappeared. We thought that the history of head trauma and another antiepileptic drug usage were the risk factors for the occurrence of valproate-induced choreiform movements.