[Acute transverse myelitis in pediatric intensive care: a 3 cases report]

Acute transverse myelitis [ATM] is a rare disorder caused by an inflammatory syndrome of the spinal cord. We report 3 cases of ATM managed in the intensive care unit of the Children's hospital of Tunis in order to precise clinical, therapeutic and prognostic particularities of the severe forms of ATM complicated with acute respiratory insufficiency [ARI]. Cases: the three patients were aged respectively of 6, 9 and 13 years. The 3 girls presented with ARI requiring mechanical ventilation in 2 cases. The diagnosis was confirmed by the cerebrospinal MRI in the 3 cases. The etiological research was negative in all cases. Intravenous methylprednisolone was given in the 3 cases. One patient died. The death was caused by acute neurovegetative disorders. At 6 months follow up, one patient was asymptomatic. The other patient had urinary incontinence and a partial lower limb weakness

Concurrent effect of morphine on thalamic nociceptive neurons and medullary on and off cells

On-and off-cells of the rostral ventromedial medulla project to the spinal cord, where off-cells are postulated to inhibit, and on-cell facilitate, nociceptive transmission. In the present experiments, unitary recordings were made from ventrobasal (VB) thalamic neurons and, simultaneously, on-or off-cells in lighhtly anesthetized rats. When the tail was heated (45-55ºC) off-cells stopped firing (pause) and on-cells began to fire (burst) 0.5-06s before VB neurons responded to the tail stimulus. Administration of morphine sulfate (2mg/kg i.v) concurrently prevented the off-cell pause, the on-cell burts an the VB neuronal response. Naloxone (1mg/kg i.v) recersed these effects. The results are consistent with the notion that prevention of the off-cell pause and the on-cell burst by morphine is responsible for the lack of nociceptive information flow towards the thalamus