[Hysteroscopy and infertility. First data from a brief study]

On the basis of short-term experience with hysteroscopy, objective evaluation of the usefulness of the technique in the diagnosis of infertility is attempted and comparison made with other techniques. An attempt is also made to pinpoint the most suitable moment in the diagnostic procedure for its use.

Cryoglobulinemic neuropathy: case report

We report the case of a 51-year-old man affected by mainly motor polyneuropathy with subacute onset and tendency to chronicization. Several possible etiological factors were present, but nerve biopsy, showing ischemic and inflammatory neuropathy, led us to consider cryoglobulinemia as the most important.

Recurrent familial neuropathy due to liability to pressure palsies

Two families with hereditary neuropathy with liability to pressure palsies (HNPP) were evaluated clinically, electrophysiologically and pathologically (2 index cases). Familial patterns suggest autosomal dominant inheritance. The clinical presentation is characteristic, with recurrent painless transitory mononeuropathy, without evident triggering factors, or caused by trivial trauma or pressure. In affected members neurophysiological studies showed diffuse slowing in nerve conduction, more evident at common sites of entrapment. Somatosensory evoked potentials (SEPs) showed bilateral peripheral abnormalities with proximal nerve involvement more pronounced in older patients. 40 to 75% of teased fibers displayed sausage-shaped swellings. Ultrastructurally some sausages showed redundant myelin loops and excessive number of myelin lamellae that seem to cause axonal constriction.

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.

Development of the rabbit model for studying the effects of propranolol on cardiac contractility: relationship of intravenous pharmacodynamics and pharmacokinetics

The New Zealand white rabbit (3-4 kg) was chosen as an experimental model to determine the effects of propranolol, by intravenous bolus administration, on cardiac contractility. The cardiovascular effects were measured by systolic time interval recordings for up to 8 h. The study was performed on two groups of animals with 5 rabbits receiving active drug and another 5 rabbits receiving saline placebo. All animals were anesthetized by parenteral administration of urethane/acepromazine. The results indicated that at 15 min after intravenous administration, propranolol caused a maximum decrease in heart rate (p less than 0.01), as well as a maximum increase in QS2 (p less than 0.01), LVET (p less than 0.01), PEP (p less than 0.01) and PEP/LVET (p less than 0.05). Approximately 90 min after drug administration, a significant (p less than 0.01) "rebound phenomenon" was observed in the active group which continued throughout the 8-h observation period. This preliminary study suggests that the rabbit is a useful animal model to study the effects of propranolol on cardiac contractility.

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.

Peripheral neuropathy associated with experimental plasma cell neoplasm in the mouse

In order to investigate the role of paraproteins in the production of neuropathy we experimentally induced monoclonal immunoglobulin-producing tumours into 32 BALB/c mice by injecting mineral oil or pristane intraperitoneally. In 11 mice morphologic and histometric studies of the sciatic nerve revealed the presence of neuropathy. Immunohistochemical studies did not demonstrate a significant amount of immunoglobulins and light chains in the endoneurium. The advantages and limits of this experimental model are discussed.

Hereditary motor neuropathy, distal type: electrophysiological and pathological studies of a case

A case of HMN, distal type transmitted as autosomal dominant is described. Clinical findings appear to be consistent with a peroneal muscular atrophy, indistinguishable from HMSN types I and II. The electrophysiological data reveal a pathological involvement of the anterior horns, whereas sensory and motor conduction are normal. A muscle biopsy showed neurogenic atrophy, while the morphology of the sural nerve was normal.

[Muscle and nerve biopsy in ambulatory surgical practice]

The diagnostic value of nerve and muscle biopsy in detecting several neurological diseases is discussed. A bioptic technique for current surgical practice is proposed.