Treatment of cervical dystonia and focal hand dystonia by high cervical continuously infused intrathecal baclofen: a report of 2 cases

We describe 2 patients, one with cervical dystonia (CD) combined with focal hand dystonia (writer's cramp) and another with idiopathic CD, who were unresponsive to oral medications and became resistant to botulinum toxin type A and B injections. Both patients were successfully treated with high cervical (C1-3) continuously infused intrathecal baclofen (ITB). Neck range of motion (ROM) was measured by using a 3-dimensional electromagnetic cervical ROM system. Pain, disability, and severity were assessed by using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The patient with CD and writer's cramp did well on a continuous baclofen dose of 186.1 microg/d. Her total TWSTRS score improved significantly, her electromagnetic measurements showed an increased in total neck flexion and extension, and her handwriting improved. Unfortunately, this patient (a heavy smoker) developed small cell carcinoma of the lung and died 9 months after her pump was placed. Total TWSTRS score and electromagnetic measurements also significantly improved after pump implant in the patient with CD. He continues to do well on a periodic bolus dose using a combination of 50 microg of baclofen and 25 microg of hydromorphone (Dilaudid) every 4 hours. Our findings suggest the potential usefulness of this therapy in other patients with focal dystonia. To our knowledge, this is the first reported successful treatment of CD and CD combined with writer's cramp with high cervical continuously infused ITB.     

Identification and quantification of lower gastrointestinal flexible endoscopic microflora

After use in 29 patients undergoing mechanical bowel preparation and cleansing by an acceptable, standardized method, flexible colonoscopes and sigmoidoscopes were cultured for identification and enumeration of bacterial organisms that might be transmitted during subsequent endoscopic procedures. Using a unique, new application, RODAC aerobic and anaerobic cultures of the shaft surface showed no evidence of residual fecal contamination, sparse growth of cutaneous and airborne organisms on some instruments, and no aerobic or anaerobic bacterial growth on others. There were no post-endoscopy infectious complications. Our results would indicate that proper cleaning of the flexible endoscope using an acceptable method does prevent bacterial disease transmission from patient to patient.     

Effects of Eimeria brunetti on intestinal pH in conventional and gnotobiotic chickens

White Leghorn cockerels, 2-4 weeks of age, inoculated with sporulated oocysts of Eimeria brunetti had a lower mean pH in the middle and lower small intestine than did uninoculated controls by 5-9 days post-inoculation. No effect of the infection on pH was seen in the upper intestine while pH in the gizzard and caeca was occasionally higher than in controls. Magnitude of pH. decrease did not correlate with increases in oocyst dosage and severity of infection as measured by lesion score. Studies with germ-free (GF) and gnotobiotic chicks showed that host bacterial flora was essential for a pH decrease in the middle and lower small intestine with E. brunetti infection. Inoculation of GF birds with Lactobacillus acidophilus or L. acidophilus plus Streptococcus faecalis, in addition to E. brunetti resulted in some decrease in pH.     

Effects of morphine, pentazocine and cyclazocine alone and in combination with naloxone on electric shock titration in the squirrel monkey.

The effects of morphine, pentazocine and cyclazocine were examined on a discrete-trial shock titration procedure. Monkeys received continuous shock during 15-sec shock periods. If the monkey did not respond during the shock period, shock remained on for 15 sec and then increased by one increment on the next 15-sec shock period. If five responses were made during the shock period, the shock was immediately terminated for 15 sec during which the chamber was dark (time out). After the 15-sec time out period, the shock resumed at the next lower intensity. Morphine, pentazocine and cyclazocine altered patterns and rates of responding similarly. At a low dose, pentazocine, cyclazocine and morphine decreased median shock levels and increased rates of responding in the presence and in the absence of shock (i.e., during time out). These effects were observed over a wider dose range with pentazocine and cyclazocine than with morphine; moreover, decreases in median shock level and increases in rates of responding in the absence of shock were of greater magnitude after pentazocine and cyclazocine than after morphine. At higher doses, morphine, pentazocine and cyclazocine increased median shock levels and decreased rates of responding in the absence of shock. Rates of responding in the presence of shock were either unchanged or decreased very slightly, suggesting that increases in the intensity at which shock is maintained under shock titration procedures is not necessarily due to decreases in rates of responding. In contrast, naloxone had very little behavioral effect when administered alone. The effects of morphine were antagonized by a dose of naloxone as low as 0.01 mg/kg, whereas higher doses of naloxone were required to antagonize the effects of pentazocine and cyclazocine.