Respiratory Sinus Arrhythmia in Cluster Headache Syndrome

SYNOPSIS
Respiratory sinus arrhythmia is regarded as indicative of cardiac vagal integrity. A ratio of the longest R-R interval to the shortest R-R interval during deep breathing test (E:I ratio) was calculated in controls (n=49), cluster headache (n=33) and CPH (n=4) patients, E:I ratio decreased with age but was not dependent upon sex or upon smoking habits. Furthermore, there were no significant differences as regards E:I ratio between cluster headache patients in and outside a bout, or between patients with right-sided and left-sided headache. However, the E:I ratio was found to be significantly lower in the cluster headache group as such, when compared with controls, but the number of patients disclosing pathological or borderline results was small, 2 and 2, respectively. This may indicate that a putative vagal dysfunction in cluster headache is usually less marked than in patients with e.g. diabetic autonomic neuropathy. Significant attack-related change in the E:I ratio were detected in all individual patients though these changes were not of a uniform nature from individual to individual. E:I ratios were rather high in 3 out of 4 CPH patients examined. However, the number of patients in this group is too small to allow definite statements about the difference between CPH end cluster headache with regard to E:I ratios. There was no significant difference between E:I ratios outside and during a mild, short, mechanically precipitated attack in a single CPH patient.     

A comparison of glue and a tube as an anastomotic agent to repair the divided buccal branch of the rat facial nerve

The best anastomotic agent to join nerve ends is controversial. This paper describes a controlled trial between a collagen tube wrap and a tissue glue to anastomose the rat facial nerve. There was no difference in the results using photographic, histological and electrophysiological techniques.     

周围神经小间隙动脉套桥接与外膜缝合比较研究

将大鼠的腓总神经切断后，进行如下４组实验：Ａ．原位３ｍｍ间隙动脉套桥接，Ｂ．原位断端外膜缝合，Ｃ远侧断端旋转１８０°３ｍｍ间隙动脉套桥接，Ｄ远侧端旋转１８０°外膜缝合。术后１２周的电生理学，组织学评价显示，Ｂ组神经再生效果最佳，Ａ、Ｃ两组接近Ｂ组，而Ｄ组较差。     

高压氧对家兔面神经撞击伤后面神经核内生长相关蛋白变化的影响(论著)

目的：研究面神经撞击伤后面神经核内生长相关蛋白（ＧＡＰ－４３）的变化及高压氧（ＨＢＯ）治疗的影响。方法：利用ＢＩＭ－Ⅱ型生物撞击机致家兔右侧面神经干损伤，应用ＳＰ免疫组化染色法观察损伤后１、３、７、１４和２１天（分别用ＨＢＯ治疗及不用ＨＢＯ为对照）面神经核内ＧＡＰ－４３的变化，并用电镜观察面神经干超微结构变化。结果：面神经损伤第１天，伤侧面神经核区ＧＡＰ－４３样免疫反应性神经元（ＧＬＩＮ）开始增多，第１４天其增多达到高峰，第２１天逐渐下降。ＨＢＯ治疗组伤后不同时期ＧＬＩＮ的增多明显高于对照组。伤后第２１天，与对照组相比ＨＢＯ组面神经干电镜观察可见较多的新生髓鞘。结论：ＨＢＯ治疗可使伤后面神经核内ＧＬＩＮ增多，因而有助于面神经损伤后的修复与再生。     

Calcitonin gene-related peptide-like immunoreactivity, in botulinum toxin-paralysed rat muscles

Changes in calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) at the motor endplates of botulinum toxin-paralysed rat muscles were investigated using immunohistochemistry. One day following toxin injection, a dramatic increase in CGRP-LI was detected at the motor endplates and within preterminal axons of the soleus and gastrocnemius muscles. The upregulation of CGRP-LI persisted throughout the period during which muscle fibres were paralysed and new neuromuscular junctions were being formed by the growing sprouts. Decline of CGRP-LI at the motor endplates coincided with clinical recovery. Both up- and down-regulation of CGRP-LI took place earlier in the soleus than in the gastrocnemius muscle. Up-regulation of CGRP-LI was also detected in a subpopulation of motor axons in the sciatic nerves and in the spinal motor neurons innervating the paralysed muscles. These results indicate that levels of CGRP are regulated, at least partly, by changes in the target innervation. They also suggest an important role for CGRP in the regenerative processes following muscle paralysis.     

带血管蒂前臂后皮神经电缆式移植修复上臂桡神经缺损

目的：介绍带血管蒂前臂后皮神经电缆式移植修复上臂桡神经缺损的应用解剖、手术方法及临床效果。方法：在２０侧成人上肢标本上，观测前臂后皮神经及桡侧副动脉的行程及外径，设计以桡侧副动脉为蒂的前臂后皮神经电缆式移植修复上臂桡神经缺损的新术式并应用于临床。结果：前臂后皮神经与桡侧副动脉伴行关系密切，具有形成带血管蒂前臂后皮神经转移的解剖学条件；前臂后皮神经横径２．０ｃｍ左右，可切取长度１５．０ｃｍ左右，折叠后可以修复７．０ｃｍ左右的桡神经缺损。同时，术中发现神经供体断端出血活跃，说明带血供的前臂后皮神经移植的血供是可靠的。临床应用８例，神经缺损３．５～６．０ｃｍ，随访１０个月～３年，效果满意。按陆裕朴介绍的评定标准：优４例，良３例，可１例。结论：该术式转移灵活，操作简单、安全、可靠，对供区影响小，是修复上臂桡神经缺损的一种有用的方法。     

A Comparative Study of the Percutaneous versus Intraoral Technique for Mental Nerve Block

Objective: Mental nerve block is frequently used to aid repair of facial lacerations; both percutaneous and intraoral approaches to blocking this nerve are used, but have never been compared. The authors compared the two techniques for pain of administration and effectiveness of anesthesia. Methods: A prospective, randomized, single-blind, crossover study was conducted using ten healthy volunteers aged 22 to 33 years. Patients having prior experience with mental nerve blocks, lidocaine allergy, active oral/facial infection, or previous facial fractures were excluded. Bilateral mental nerve blocks were done using intraoral technique on one side and percutaneous technique on the other. Both techniques were used by the same investigator and were carried out with 27-gauge needles and 2.5 mL of 2% buffered lidocaine at room temperature injected over 20 seconds. The oral mucosa was topically anesthetized with viscous lidocaine for 1 minute prior to intraoral injection. The orders of the blocks and sides of the face anesthetized were randomized. Subjective and objective pain (visual-analog scale), efficacy (anesthesia of lower lip), time to onset, and duration of anesthesia were evaluated. Results: The intraoral technique was subjectively less painful than the percutaneous approach in nine of ten subjects (p = 0.02). Scores on the visual-analog pain scale were significantly lower for the intraoral technique (p = 0.03). Intraoral injection produced lower-lip anesthesia in 10/10 subjects versus 7/10 for percutaneous (p = 0.25). Times to onset (approximately 1–2 minutes) and durations of anesthesia (approximately one hour) were similar for the two techniques. Conclusion: The intraoral approach to the mental nerve block with adjunctive topical anesthesia was subjectively and objectively less painful than the percutaneous approach without adjunctive anesthesia. While the intraoral approach had a greater efficacy of lower-lip anesthesia and a longer duration of action, these differences were not statistically significant.     

Ventrally emigrating neural tube cells migrate into the developing vestibulocochlear nerve and otic vesicle

Virtually all cell types in the inner ear develop from the cells of the otic vesicle. The otic vesicle is formed by the invagination of non-neural ectodermal cells known as the otic placode. We investigated whether a recently described cell population, originating from the ventral part of the hindbrain neural tube known as the ventrally emigrating neural tube (VENT) cells, also contributes cells to the otic vesicle. The ventral hindbrain neural tube cells were labeled with the fluorescent vital dye DiI or replication-deficient retroviruses containing the LacZ gene in chick embryos on embryonic day 2, after the emigration of neural crest from this region. One day later, the labeled cells were detected only in the hindbrain neural tube. Shortly thereafter, the labeled cells began to appear in the eighth (vestibulocochlear) cranial nerve and otic vesicle. From embryonic day 3.5-5, the labeled cells were detected in the major derivatives of the otic vesicle, i.e. the endolymphatic duct, semicircular canals, utricle, saccule, cochlea, and vestibulocochlear ganglion. That the emigrated cells originated from the ventral part of the hindbrain neural tube was confirmed by focal application of DiI impregnated filter paper and with quail chimeras. It is concluded that, in addition to the otic placode cells, the otic vesicle also contains the ventrally emigrating neural tube cells, and that both cell populations contribute to the structures and cell types in the inner ear. It is well known that inductive signals from the hindbrain are required for the morphogenesis of the inner ear. The migration of the hindbrain neural tube cells into the otic vesicle raises the possibility that the inductive effect of the hindbrain might be mediated, at least in part, by the ventrally emigrating neural tube cells and that, therefore, a mechanism exists that involves cells rather than diffusible molecules only.     

Widenings of the myelin lamellae in a typical Guillain–Barré syndrome

The so-called “widenings of the myelin lamellae” are thought to be specific ultrastructural features of peripheral nerve myelin in patients with peripheral neuropathy associated with a monoclonal dysglobulinemia of IgM type and antiglycolipid activity. We report here a case of Guillain–Barré syndrome with no evidence of serum monoclonal dysglobulinemia, presenting the typical widenings of the myelin lamellae in small-diameter myelinated fibers from a sural nerve biopsy. In view of the positive reaction with anti-C3d complement on direct immunofluorescence, an immunological mechanism may be involved in the widenings of the myelin lamellae. © 1994 John Wiley & Sons, Inc.