Cervical root stimulation in the diagnosis of radiculopathy

Cervical root stimulation (CRS) was compared with conventional EMG, nerve conduction, and late response studies in 34 patients with possible cervical radiculopathy. Cervical roots were stimulated by monopolar needles inserted into paraspinal muscles, recording compound muscle action potentials in biceps, triceps, and abductor digiti minimi muscles. In 18 patients with clinical evidence of radiculopathy, EMG was abnormal in 11 (61%), but CRS was abnormal in all 18. Of 16 patients with symptoms but no signs of radiculopathy, EMG was abnormal in 5 (31%) and CRS was abnormal in 9 (56%).     

Classification treesA possible method for iso-resource grouping in intensive care

Classification and grouping of clinical data into defined categories or hierarchies is difficult in intensive care practice. Diagnosis-related groups are used to categorise patients on the basis of diagnosis. However, this approach may not be applicable to intensive care where there is wide heterogeneity within diagnostic groups. Classification tree analysis uses selected independent variables to group patients according to a dependent variable in a way that reduces variation. In this study, the influence of three easily identified patient attributes on their length of intensive care unit stay was explored using classification analysis. Two thousand five hundred and forty-five critically ill patients from three hospitals were classified into groups so that the variation in length of stay within each group was minimised. In 23 out of 39 terminal groups, the interquartile range of the length of stay was ≤ 3 days.     

Abnormal single motor unit behavior in the upper motor neuron syndrome

We studied the discharge pattern of single motor units (SMUs) in the left and right biceps muscles from a patient with nonspastic weakness of the left arm. Detailed statistical analysis of the behavior of discharge patterns of 4 of 4 single motor units on the affected side showed abnormalities with characteristic features of an upper motor neuron lesion. Five out of 5 single motor units recorded from the right biceps were normal. An upper motor neuron lesion affecting the left arm, predicted by our results, was confirmed by magnetic resonance imaging (MRI), which showed a lesion in the right precentral gyrus. It appears that changes in single motor unit firing characteristics, caused by an upper motor neuron lesion, can be detected at a time when there is no evidence of increased "tone" and/or hyperreflexia (spasticity) in the affected extremity.     

Radioprotective Effect of Achillea millefolium L Against Genotoxicity Induced by Ionizing Radiation in Human Normal Lymphocytes

The radioprotective effect of Achillea millefolium L (ACM) extract was investigated against genotoxicity induced by ionizing radiation (IR) in human lymphocytes. Peripheral blood samples were collected from human volunteers and incubated with the methanolic extract of ACM at different concentrations (10, 50, 100, and 200 μg/mL) for 2 hours. At each dose point, the whole blood was exposed in vitro to 2.5 Gy of X-ray and then the lymphocytes were cultured with mitogenic stimulation to determine the micronuclei in cytokinesis-blocked binucleated cell. Antioxidant capacity of the extract was determined using free radical-scavenging method. The treatment of lymphocytes with the extract showed a significant decrease in the incidence of micronuclei binucleated cells, as compared with similarly irradiated lymphocytes without any extract treatment. The maximum protection and decrease in frequency of micronuclei were observed at 200 μg/mL of ACM extract which completely protected genotoxicity induced by IR in human lymphocytes. Achillea millefolium extract exhibited concentration-dependent radical-scavenging activity on 1,1-diphenyl-2-picryl hydrazyl free radicals. These data suggest that the methanolic extract of ACM may play an important role in the protection of normal tissues against genetic damage induced by IR.     

Tuberculous otitis media presenting as complications: report of 18 cases.

Tuberculous otitis media is a rare but treatable disease; delay in its diagnosis usually leads to complications. In the last 15 years we have come across 18 cases of tuberculous otitis media, which presented various intra- and extracranial complications. In the past, tuberculous otitis media had always been considered a discrete disease, but it is possible that tuberculosis may coexist or secondarily affect an already discharging ear. The following discussion illustrates the complications and clinical problems encountered in tuberculous otitis media.     

Contraceptive efficacy of norethindrone acetate (ENTA) implant: its release rate and fertility potential

The contraceptive efficacy of norethindrone acetate (ENTA) implant was evaluated in a study of 79 healthy volunteers aged 19-30 years. The purpose of the study was to 1) relate the menstrual pattern to the average daily release rate of the hormone, 2) assess the concentration of NET in peripheral blood in cases of unintentional pregnancies and ascertain the risk to offspring in such cases, and 3) evaluate the fertility potential and menstrual pattern in the 1-year period after implant removal. In most subjects (59), the implant was removed between the 5th and 8th month. The average release rate was found to be 163.5 mcg/day in subjects with regular menstrual cycles (cycle interval of 25-32 days) compared with 190.9 mcg/day in those with an abnormal menstrual pattern (p0.05). The rate was 143.3 mcg/day in the 19 women who became pregnant during the trial, but this difference is not significant. 15 of the 19 pregnancies occurred between 4 and 8 months, suggesting that the contraceptive efficacy of this implant does not exceed 4-5 months. Mean NET concentration in the sera of the women who became pregnant was 122.5 pg/ml at the time of pregnancy diagnosis. Only 10 subjects complied with the recommendation that their pregnancy be terminated for medical indications. The remaining 9 subjects delivered 6 female and 3 male infants who appeared to clinically normal, despite the fact that 4 had been exposed to the steroid for over 6 weeks. 1 year follow-up was possible in 52 subjects. The menstrual pattern appeared to be regular during this period. 25 of the 44 women in this follow-up group who did not use contraceptive measures became pregnant during the 1st year after implant removal. Additionally, the 9 infants delivered to women during the study period were evaluated for 2-3 years. No adverse changes in growth and development have been observed. This finding suggests that reports associating teratogenicity and progestins in early pregnancy are exagerrated.     

The effect of alcohol on essential tremor.

Five patients with essential tremor had a dramatic diminution in tremor amplitude within 15 minutes of ingesting small doses of ethyl alcohol. The same patients were given equivalent amounts of ethyl alcohol infused into a brachial artery, and there was no decrease in tremor amplitude in the perfused limb. It is concluded that, in patients with essential tremor, ethanol acts in a specific fashion on sensitive structures within the central nervous system and has no effect on peripheral tremorogenic mechanisms. This provides additional evidence for a central mechanism in essential tremor, distinguishing it from other tremors arising primarily from oscillation in peripheral servo-loops.