EEG findings in the persistent vegetative state.

The definition of the persistent vegetative state (PVS) is relatively straightforward, but its diagnosis can be challenging. We reviewed a series of EEG performed in patients with PVS to assess the diagnostic value of EEG. We reviewed records of all hospital patients with a diagnosis of persistent vegetative PVS. EEG findings included normal, continuous generalized slowing, intermittent generalized slowing, background slowing, background suppression, alpha, generalized periodic pattern, PLEDS, and triphasic waves. EEG findings had no association with etiology and varied from one pattern to another in the same patients' EEGs obtained at different times (see table). We conclude that EEG findings in PVS are heterogeneous and too variable to be of diagnostic value.     

In vitro and in vivo effects of methyl isocyanate on rat brain mitochondrial respiration

The present study deals with the in vitro and in vivo effects of methyl isocyanate (MIC) on rat brain mitochondrial function. Addition of MIC to tightly coupled brain mitochondria in vitro resulted in a mild stimulation of state 4 respiration, abolition of respiratory control, decrease in ADP/O ratio, and inhibition of state 3 oxidation. The oxidation of NAD⁺-linked substrates (glutamate + malate) was more sensitive (fourfold) to the inhibitory action of MIC than succinate while cytochrome oxidase was unaffected. Administration of MIC subcutaneously at a lethal dose affected respiration only with glutamate + malate as the substrate (site I) and caused a 20% decrease in state 3 oxidation leading to a significant decrease in respiratory control index while state 4 respiration and ADP/O ratio remained unaffected. As both the malondialdehyde and iron contents of brain mitochondria were not altered, it may be inferred that the observed in vivo inhibition of state 3 oxidation is induced by MIC through systemic stagnant hypoxia leading to ischemia of brain, which further contributes to the cerebral hypoxia.     

Nasogastric intubation and elective abdominal surgery.

The use of nasogastric tubes after elective abdominal surgery remains standard practice for many surgeons. Such tubes, however, cause much discomfort and are associated with significant morbidity. This paper reviews the arguments for and against nasogastric intubation, and finds little evidence to support its continued routine use.