Subarachnoid sufentanil as sole agent vs standard spinal bupivacaine in transurethral resection of the bladder

AIM

The aim of the study was to determine whether intrathecal sufentanil alone provides an adequate analgesia for patients undergoing transurethral resection of the bladder (TURB) and to compare it to standard spinal bupivacaine anesthesia in terms of motor and sensory blockade, discharge time and side effects.

METHODS

Sixty-two patients were blindly and randomly assigned to receive either intrathecal bupivacaine (10 mg of 0.5% hyperbaric bupivacaine) or intrathecal sufentanil (15 microg). Motor and sensory blockade was evaluated using a modified Bromage scale as well as cold and pinprick tests. Severity of pain was assessed by means of a 10-point verbal analog scale.

RESULTS

We found that the mean duration of sensory blockade was similar for both sufentanil and bupivacaine patients but the quality of analgesia induced by sufentanil alone was poor as compared with spinal bupivacaine anesthesia.

CONCLUSION

The subarachnoid administration of sufentanil 15 mg seems to be inadequate for TURB surgery. In addition, the advantage of a faster recovery we observed in sufentanil patients is minimized by the occurrence of a troublesome symptom such as pruritus. On the other hand, spinal bupivacaine produces an undesirable motor blockade exceeding, in our opinion, the requirement for TURB procedure.

Similar low frequency of anti-MOG IgG and IgM in MS patients and healthy subjects

The authors used a liquid-phase radiobinding assay to measure serum anti-myelin oligodendrocyte protein (MOG) immunoglobulin (Ig) G in 87 patients with multiple sclerosis (MS), in 12 patients with encephalomyelitis, and in 47 healthy subjects. Anti-MOG IgM was determined in samples obtained at onset from 40 of 87 patients with MS and in control subjects. The frequency of positive samples with low titers of anti-MOG IgG (< or =5.7%) and IgM (< or =8.3%) was similar in all the groups and subgroups. Binding competition experiments showed that these antibodies had low affinity. Anti-MOG antibodies are not disease specific.

Immunoglobulins in chronic inflammatory demyelinating polyneuropathy

This article reviews the efficacy and tolerability of intravenous immunoglobulins (IVIg) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), including those forms associated with monoclonal gammopathy (paraproteinemic demyelinating neuropathy, PDN). Class I trials demonstrated that IVIg are effective in CIDP. About two-thirds of patients respond to initial treatment; however, most of them require repeated drug doses to maintain improvement. For PDN there are some evidences that IVIg are efficacious; however, it seems that less than 50% of the patients respond to this treatment and the persistence of the response over time has not been thoroughly investigated. The safety profile of immunoglobulins is generally good; however, the possibility of the occurrence of serious adverse effects should always be considered before starting treatment.

Quantum algorithms for Josephson networks

We analyze possible implementations of quantum algorithms in a system of (macroscopic) Josephson charge qubits. System layout and parameters to realize the Deutsch algorithm with up to three qubits are provided. Special attention is paid to the necessity of entangled states in the various implementations. Further, we demonstrate explicitly that the gates to implement the Bernstein-Vazirani algorithm can be realized by using a system of uncoupled qubits.

Shot noise for resonant Cooper pair tunneling

We study intrinsic noise of current in a superconducting single-electron transistor, taking into account both coherence effects and Coulomb interaction near a Cooper pair resonance. Because of this interplay, the statistics of tunneling events deviates from the Poisson distribution and, more important, it shows even-odd asymmetry in the transmitted charge. The zero-frequency noise is suppressed significantly when the quasiparticle tunneling rates are comparable to the coherent oscillation frequency of Cooper pairs.

Re-entrant spin susceptibility of a superconducting grain

We study the spin susceptibility chi of a small, isolated superconducting grain. Because of the interplay between parity effects and pairing correlations, the dependence of chi on temperature T is qualitatively different from the standard BCS result valid in the bulk limit. If the number of electrons on the grain is odd, chi shows a re-entrant behavior as a function of temperature. This behavior persists even in the case of ultrasmall grains where the mean level spacing is much larger than the BCS gap. If the number of electrons is even, chi(T) is exponentially small at low temperatures.

Slow deep breathing prevents the development of tachygastria and symptoms of motion sickness

BACKGROUND

The purpose of this study was to see if slow deep breathing, a non-pharmacological procedure known to increase parasympathetic nervous system (PNS) activity, would prevent the development of gastric dysrhythmias and symptoms of motion sickness when subjects were exposed to a rotating optokinetic drum.

METHODS

Participating in this study were 46 healthy males and females aged 17-26 who were pre-tested in the rotating drum and found to be susceptible to motion sickness. They were randomly placed into one of the following three conditions: Slow Deep Breathing (n = 18), Counting Breaths (subjects were asked to count their breaths and asked for the count every 3 min, n = 16), and Control (subjects breathed normally, n = 12). Electrogastrograms were recorded from all subjects during a 6-min baseline and a 16-min rotation period. Subjects were asked about their symptoms every 3 min.

RESULTS

A significant difference in percent tachygastria from baseline to rotation was found between the three conditions. Percent tachygastria increased during rotation for the Counting Breaths group and the Control group, but remained the same as baseline for the Slow Deep Breathing group. The Slow Deep Breathing group (5.3) reported significantly fewer symptoms than the Counting Breaths group (9.0), but not the Control group (7.8).

CONCLUSION

In conclusion, slow deep breathing in a situation previously demonstrated to provoke tachygastria prevented the development of gastric dysrhythmias and decreased symptoms of motion sickness.

Docetaxel neuropathy: a distal axonopathy

Docetaxel has been implicated as a causative agent in peripheral neuropathy, but pathological changes in peripheral nerve have not been described. During docetaxel treatment a 54-year-old man developed a sensorimotor polyneuropathy when the overall docetaxel dosage was 540 mg/m(2). Neurophysiological investigation revealed a sensorimotor axonal neuropathy. Fascicular sural nerve biopsy showed an axonal neuropathy with a preferentially loss of large myelinated fibers. There was evidence of considerable fiber regeneration. Sensory and motor symptoms progressively improved after docetaxel withdrawal.

Effects of gender of subjects and experimenter on susceptibility to motion sickness

BACKGROUND

It has been reported that females are more susceptible to motion sickness than males, but these reports have failed to take into account the possible effects of the gender of the experimenter and the subjective nature of reports of symptoms of motion sickness. To deal with the first possible confound, we used male and female experimenters. To deal with the second issue, we recorded gastric myoelectric activity so as to be able to quantify gastric tachyarrhythmia, an objective measure that has been shown previously to correlate highly with severity of symptoms.

METHOD

There were 34 male and 34 female participants were assigned to either a male or female experimenter. Symptoms of motion sickness were induced by placing participants in an optokinetic drum for an 8-min baseline period followed by a 16-min rotation period. Electrogastrograms (EGGs) were continuously recorded, and reports of symptoms were obtained from the participants every 3 min during rotation.

RESULTS

Comparison of male and female subjects' symptom scores revealed that females had higher symptom scores than males; however, no significant main effects for gender of the subject or experimenter were found. However, on a post-session questionnaire, females reported experiencing significantly more GI symptoms than males. Gender comparisons of the change in gastric tachyarrhythmia power from baseline to rotation yielded no significant differences.

CONCLUSIONS

Females report more overall symptoms of motion sickness and significantly more GI symptoms than males, but do not show greater increases in gastric tachyarrhythmia during exposure to a rotating drum.

Subconjunctival versus intrascleral mitomycin-C in trabeculectomy

BACKGROUND AND OBJECTIVE

A randomized prospective comparison of sub-Tenon's administration of mitomycin-C (MMC) with intrascleral administration of MMC in trabeculectomy was performed to determine whether intrascleral application is superior to the standard sub-Tenon's application.

PATIENTS AND METHODS

Twenty-four eyes of 23 patients were randomized to treatment with MMC (0.27 mg/ml for 5 minutes). The route of administration was subconjunctival in group A and intrascleral in group B. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), number of medications, and complications were compared between the two groups.

RESULTS

There was no statistically significant difference between the two groups preoperatively regarding VA, IOP, and number of medications. Postoperatively, IOP and number of medications required had decreased significantly in both groups. A significantly larger number of postoperative procedures were required in group B to control IOP (group A = 3, group B = 14, P = .002).

CONCLUSION

Both methods of MMC application significantly decreased the IOP and the number of medicines required to control IOP after trabeculectomy. The intrascleral use of MMC resulted in the need for more surgery postoperatively (P = .002).

Clinical and neurophysiological assessment of immunoglobulin therapy in five patients with multifocal motor neuropathy

High dose intravenous immunoglobulin (IVIg) is an effective treatment for demyelinating neuropathies. IVIg was given to five patients with multifocal motor neuropathy, a motor neuropathy showing a clinical syndrome of asymmetrical weakness and amyotrophy, electrophysiological evidence of motor conduction block and, in many cases, high titres of serum anti-GM1 antibodies. Muscle strength was evaluated by a conventional score before and after each IVIg course. In all patients there was relevant improvement on muscle strength after each immunoglobulin course, but in most cases the clinical benefits partially declined after three to eight weeks. At the eight month follow up, however, the pretreatment examination showed a significant improvement compared with the initial evaluation. The effects of each IVIg course were still present after a number of courses. Electrophysiological study revealed a decrease in conduction block in one or more nerves in all patients. However, conduction block was unchanged or increased in other sites. IVIg treatment did not affect anti-GM1 antibody titres.

Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating neuropathy not responsive to other treatments

Nine patients with chronic inflammatory demyelinating poliradiculoneuropathy (CIDP) were treated with intravenous immunoglobulin. All patients had been previously treated with prednisone and/or plasma exchange without effect. Objective improvement in clinical condition occurred in six patients. One patient became refractory after two treatment courses, two patients had no response. The results indicate that intravenous immunoglobulin has beneficial effects in a high percentage of patients with CIDP who are unresponsive to other treatments.

Serum antibodies to Purkinje cells and dorsal root ganglia neurons in sensory neuronopathy without malignancy

Anti-Purkinje cell antibodies (APCA), believed to be markers of paraneoplastic cerebellar degeneration in females, have been identified in the serum of 3 men with subacute sensory neuronopathies and no evidence of tumors 5 years after the onset of the neurological signs. By indirect immunohistochemistry on sections of rat cerebellum and dorsal root ganglia, the patients' IgG bound to the cytoplasms of both Purkinje cells and dorsal root ganglia neurons. By western blot analysis on whole human cerebellum and whole human dorsal root ganglia homogenates, the IgG from 2 patients bound to a 62-kd protein in both homogenates and the IgG from 1 patient bound to a 110-kd protein in the cerebellum homogenate only. Yo autoantibody test was negative in all patients. Our study provides evidence that non-anti-Yo APCA may be associated with subacute sensory neuronopathies and are not necessarily markers of an underlying tumor. The previously described anti-Yo APCA has only occurred in females with cancer.

Coexistence of growth hormone-secreting pituitary adenoma and intracranial meningioma: a case report and review of the literature

The simultaneous occurrence of a pituitary adenoma and an intracranial meningioma is a rare event. We report the coexistence of an eosinophilic pituitary adenoma and a endotheliomatous meningioma, in the sellar region, and evaluate their endocrine, neuro-radiological and immunohistochemical pattern. A 47-year-old woman affected by acromegaly was referred to us. Serum GH level was 82 ng/ml and remained unresponsive to both OGTT (75 g per os) and iv. GHRH 1-29 (100 micrograms); IGF-1 was 807 ng/ml. Eight hours after acute sc administration of octreotide (100 micrograms) GH returned to normal levels (2.3 ng/ml). CT scan showed a large intra- and suprasellar mass involving the right cavernous sinus, with a retrosellar extension along the tentorium. A slight and inhomogeneous enhancement, with a periferal rim of bright signal was apparent at MRI. Conversely, the retrosellar component showed a bright homogeneous enhancement. The patient, therefore, underwent neurosurgery. Histological examination revealed the coexistence of 2 types of tissue: areas of endotheliomatous meningioma were interspersed among sheets of acidophilic adenoma tissue. Immunohistochemical analysis was performed in order to determine the relationship between the two masses: a positive staining for GH was shown in the areas of adenoma, as against for GHRH, neither in the adenomatous tissue nor in the slices of meningioma. Although MRI showed a latero-sellar post-surgical residual of meningioma, serum GH value was < 1 ng/ml. In conclusion, the relationship between the GH-secreting adenoma and the meningioma is unclear; however the GH-hypersecretion is not induced by a hypothetic GHRH-activity from the meningioma.

Four-week safety and efficacy study of dorzolamide, a novel, active topical carbonic anhydrase inhibitor

OBJECTIVE

To investigate the activity and local and systemic safety of the topical carbonic anhydrase inhibitor, dorzolamide hydrochloride.

DESIGN

Four-week, double-masked, randomized, placebo-controlled, parallel, three-center study.

SETTING

Referral centers.

PATIENTS

Forty-eight patients with bilateral open angle glaucoma or ocular hypertension and intraocular pressure (IOP) greater than 22 mm Hg entered the study. Two of 28 patients receiving dorzolamide and two of 20 patients receiving placebo were withdrawn due to adverse experiences.

INTERVENTION

Dorzolamide (2%) or placebo to each eye three times daily for 4 weeks.

MAIN OUTCOME MEASURES

Diurnal IOP curves; ophthalmologic evaluations including corneal ultrasound pachymetry and endothelial cell count; and systemic evaluations including vital signs, blood chemistries, complete blood cell counts, urinalysis, electrocardiogram, and drug and carbonic anhydrase activity levels in red blood cells.

RESULTS

Mean IOP at morning trough (8 AM) decreased from 27.1 mm Hg at baseline to 23.5 mm Hg on day 29 with dorzolamide (-13.3%) compared with a decrease from 27.1 mm Hg to 26.4 mm Hg with placebo (-2.3%). Peak activity occurred 2 hours after administration, with IOP decreasing from 26.8 mm Hg at baseline to 21.8 mm Hg on day 29 with dorzolamide (-18.4%) vs 26.1 mm Hg to 25.5 (-2.4%) with placebo. Mean corneal thickness was slightly increased for the dorzolamide-treated group compared with the placebo-treated group (0.009 mm vs 0.001 mm, respectively, P < .05) and changes in endothelial cell counts were similar (-24 cells/mm2 vs -27 cells/mm2, respectively, P > .25). Mean carbonic anhydrase isoenzyme II activity in red blood cells decreased to 21% of baseline in dorzolamide-treated patients. There were no clinically significant differences in ocular or laboratory parameters between the dorzolamide and placebo groups.

CONCLUSIONS

Dorzolamide demonstrated significant IOP lowering activity over 4 weeks. It was well tolerated and there were no clinically significant changes in ocular or systemic safety parameters.

Acute presentation of Tangier polyneuropathy: a clinical and morphological study

We describe a patient with Tangier disease and a peripheral neuropathy with an unusual acute onset. The morphological studies of sural nerve biopsy revealed both axonal degeneration and demyelination, and the fiber loss was preferentially restricted to two of ten nerve fascicles. The cytoplasm of Schwann cells, fibroblasts, macrophages and pericytes were vacuolated because of the presence of numerous lipid droplets. The clinical and morphological findings are consistent with the possibility that ischemia plays a major role in causing this neuropathy.

Effect of hypothyroidism on rat peripheral nervous system

The function and structure of the peripheral nervous system of Sprague-Dawley rats, 3 months after the induction of hypothyroidism by administration of N-propylthiouracil in drinking water, has been studied. The motor action potential amplitude of the caudal nerve showed a significant reduction (p < 0.001) when compared with an age-matched control group of animals. Computer-assisted morphometric analysis of sciatic nerves of hypothyroid rats showed normal distribution and density of myelinated fibers, and a normal axon/myelin ratio. Electron microscopy revealed only minor alterations in axons of myelinated fibers characterized by a dissolution of neurotubules. After two months of substitution therapy these effects were reversed. The present data suggest that early impairment of nerves induced by hypothyroidism is rare and could be related to metabolic alterations rather than to structural changes and is reversible with hormone treatment.

Antibodies to sulfatide and to chondroitin sulfate C in patients with chronic sensory neuropathy

Sera from eight of 25 patients with chronic sensory neuropathy had high titers of antibodies to sulfatide and chondroitin sulfate C or both. Preclearing of patients' sera with either sulfatide or chondroitin sulfate C revealed that in four patients the antisulfatide antibodies crossreacted with chondroitin sulfate C. By indirect immunohistochemistry sera reactive to sulfatide only had a different staining pattern from those reactive to both sulfatide and chondroitin sulfate C. By direct immunohistochemistry we found immunoglobulins bound to nerve fibers only in patients with serum antibodies against both sulfatide and chondroitin sulfate C. Our study provides evidence that antibodies to sulfatide and to chondroitin sulfate C differ in their fine specificity and are present in 30% of patients with chronic sensory neuropathy.

IgG monoclonal proteins from patients with axonal peripheral neuropathies bind to different epitopes of the 68 kDa neurofilament protein

We describe three patients with a sensorimotor axonal polyneuropathy and an IgG M-protein that binds to a 68 kDa axonal protein identified as the low molecular weight neurofilament protein (NF-L). The immunological studies revealed that the M-proteins have different target epitopes: one is phosphorylated and the other two are nonphosphorylated. One of the nonphosphorylated epitopes is common to other intermediate filaments, such as desmin and vimentin.

Axonal neuropathy in a patient with monoclonal IgM kappa reactive with Schmidt-Lantermann incisures

We report a patient with a progressive, predominantly sensory neuropathy and a IgM kappa M-protein that binds to Schmidt-Lantermann incisures. A sural nerve biopsy showed primary axonal damage and IgM deposits at Schmidt-Lantermann incisures were seen by direct immunoperoxidase. Serum from the patient injected into rat sciatic nerve reacts with the incisures as with those in the patient's nerve. The IgM kappa M-protein reacts with chondroitin sulfate C and binds to a broad nerve protein band with a mobility of between 170 and 118 kDa. Peripheral neuropathy may be related to the M-protein, which had immunocytochemical reactivity not previously described for patients with polyneuropathy and IgM monoclonal gammopathy.

Polyneuropathy associated with IgA monoclonal gammopathy: a hypothesis of its pathogenesis

We describe three patients with chronic progressive polyneuropathy associated with IgA monoclonal gammopathy. Two patients had a prominent sensory neuropathy and one had a prominent motor neuropathy. Sural nerve biopsies showed axonal degeneration in all cases. In immunocytochemical studies patients' IgG immunostained axons. By Western immunoblot a band of IgG reactivity with an axonal protein of 66 kDa was found. No band of IgA and IgM were found. We suggest the possibility that the IgA monoclonal protein may act as a stimulating factor of preexisting B cell clones eliciting an immune reaction against nerve antigens.

Axonal neuropathy with monoclonal IgG kappa that binds to a neurofilament protein

We report a 74-year-old woman with a slowly progressive sensory motor axonal neuropathy and a monoclonal IgG-kappa that bound to a 68-kd axonal protein identified as the low molecular weight neurofilament protein. The sera of control subjects and disease controls did not bind to neurofilament protein.

Cerebral multiple glio-vascular dysplasias--a case report

We describe the clinical and neuropathologic features of a patient complaining of increased intracranial pressure lasting over two years. Brain CT showed three cystic lesions in the supratentorial regions. Autopsy disclosed multiple small glio vascular abnormalities, in some instances connected with a cystic cavity. The lesions were scattered throughout the white matter of both cerebral hemispheres and suggested a complex dysplasia.

Cryoglobulinaemic neuropathy. A clinical, morphological and immunocytochemical study of 8 cases

Clinical, pathological and immunocytochemical studies are described for 8 patients with cryoglobulinaemia and peripheral neuropathy: 5 had essential cryoglobulinaemia and 3 secondary cryoglobulinaemia. The cryoglobulins in 2 cases were type II (mixed cryoglobulins with a monoclonal component), type III (mixed polyclonal cryoglobulins) in 2 others, and were not characterized in 4. In all patients the neuropathy had an acute or subacute onset and in 7 it was initially asymmetric but, during the illness, in 3 it gradually progressed to a symmetric sensorimotor polyneuropathy. All patients had sural nerve biopsies. In 4 there was widespread vasculitis with necrosis of vessel walls and perivascular inflammatory cells. In another 2, thickening of vessel walls and luminal narrowing without inflammatory cell infiltration, together with loss of myelinated fibres from single fascicles or focally within fascicles, suggested that the neuropathy was of vascular origin. In all patients the main pathological damage was axonal degeneration. Signs of axonal regeneration were rare. The total number of myelinated fibres was reduced in all cases, from 24 to 95% below the lower limit of normal control values. Large diameter fibres were lost preferentially in 7 patients, being below 16.5% of the total number. Several possible pathogenetic mechanisms have been suggested for cryoglobulinaemic neuropathy, including immunologically mediated demyelination and ischaemic injury due to intravascular deposits of cryoglobulins or vasculitis. Our observations therefore confirm a major role for ischaemic factors, secondary to inflammatory vascular destruction, in the pathogenesis of peripheral neuropathy in most cases of types II and III cryoglobulinaemia.

Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases

Clinical, neurophysiological and morphological studies of four patients with polyneuropathy and secondary hypothyroidism are reported. Neurophysiological studies revealed signs of muscle denervation and reduction of conduction velocity in all the patients. Sural nerve biopsies showed axonal degeneration in all cases but one. All the patients were treated with replacement therapy and clinical symptomatology and neurophysiological parameters improved in all patients.

Peripheral neuropathy associated with Crohn's disease

Peripheral neuropathy in Crohn's disease has been described, to date, only with vitamin B12 deficiency or as due to oral metronidazole treatment. We report the association of Crohn's disease and peripheral neuropathy in two patients in whom neither of these pathogenetic factors of nerve damage apply. The CSF of both was normal. Patient 1 has had Crohn's disease for 12 years with predominantly sensory distal neuropathy and recurrent course related to worsening and improvement of the enteritis. Patient 2 had Crohn's disease some years before symptoms of recurrent sensory loss in the feet. Axonal degeneration was the mechanism of nerve damage in both patients.