Intrathecal methotrexate-induced acute chorea.

Intrathecal methotrexate is the mainstay of central nervous system prophylaxis in acute lymphoblastic leukemia. We describe a patient who developed acute chorea after last dose of intrathecal methotrexate therapy and recovered completely.

The relation of testosterone levels with fatigue and apathy in Parkinson's disease.

OBJECTIVE: Fatigue and apathy are frequent in patients with Parkinson's disease (PD). Testosterone deficiency in male patients may contribute in development of fatigue and apathy as well. We investigated whether a possible relation exists between serum testosterone levels, fatigue and apathy in male PD patients. MATERIALS AND METHODS: We included 29 non-demented and non-depressed PD patients and 30 age- and sex-matched healthy subjects. Fatigue Severity Scale (FSS) and Apathy Evaluation Scale (AES-C) were used for the evaluations. In PD patients and healthy subjects, a relationship between FSS, AES-C scores and plasma testosterone levels were assessed. In addition, a correlation between FSS, AES-C and Unified Parkinson's Disease Rating Scale was investigated in PD group. RESULTS: The mean scores of FSS and AES-C were significantly higher in PD patients than those of the control group. The Unified Parkinson's Disease Rating Scale (UPDRS) scores were significantly correlated with FSS and AES-C scores. Mean free testosterone level was significantly lower in PD patients than controls (p=0.008). f-Testosterone levels of PD patients were not correlated with FSS or AES-C scores. CONCLUSION: Apathy and fatigue are frequent in PD and show significant correlation with the severity of the disease. f-Testosterone levels are not related with apathy or fatigue in male PD patients and the role of testosterone in the pathophysiology of these non-motor symptoms is still controversial.

Diagnosis and management of laryngopharyngeal reflux disease.

PURPOSE OF REVIEW: Recent publications have seemed to clarify the controversies that existed in the diagnosis of laryngopharyngeal reflux and have shed light on the therapy. The present article reviews recent publications in the diagnosis and management of laryngopharyngeal reflux. RECENT FINDINGS: In laryngopharyngeal reflux, laryngeal pathology results from small amounts of acid causing damage to laryngeal tissues and producing localized symptoms. None of these symptoms is pathognomonic. The new outcome assessment tool, the quality-of-life instrument, provides a self-assessment tool. Detection of pepsin in throat sputum by immunoassay provides a sensitive method to detect laryngopharyngeal reflux, although further evaluation is needed. A meta-analysis of upper-probe measurements has clarified that acid exposure time is very reliable in differentiating normal subjects from patients with laryngopharyngeal reflux. Long-term aggressive acid suppression with proton-pump inhibitors is necessary to treat laryngopharyngeal reflux. Pre-therapy abnormalities of the arytenoids and vocal cords appear to be associated with better symptom response. SUMMARY: Recent studies have revealed useful information on the diagnosis of laryngopharyngeal reflux, although further clarification is needed. Treatment protocols should be further evaluated by double-blinded, placebo-controlled multidisciplinary studies.

Cricopharyngeal muscle electromyography in laryngopharyngeal reflux.

OBJECTIVES/HYPOTHESIS: The objective was to determine whether laryngopharyngeal reflux was associated with an electrophysiological abnormality of the main part of the upper esophageal sphincter, namely, the cricopharyngeal muscle, which could be related to laryngopharyngeal reflux symptoms. STUDY DESIGN: A prospective study of 20 patients with symptoms of laryngopharyngeal reflux. METHODS: The diagnosis was based on clinical, laryngoscopic, and ambulatory 24-hour pH monitoring findings. Double-probe pH monitoring was performed with placement of the distal and proximal probes 5 cm above the proximal border of the lower esophageal sphincter and 15 cm proximal to the distal probe, in or just beneath the upper esophageal sphincter. Electromyographic recordings were obtained simultaneously on submental and cricopharyngeal muscles during water swallowing. The peak of the submental electromyographic amplitude and its duration was measured using bipolar surface electrodes placed under the chin. The electromyographic features of the cricopharyngeal muscle were investigated by means of concentric needle electrodes inserted percutaneously both in 20 normal subjects and in 20 patients with laryngopharyngeal reflux. RESULTS: All electrophysiological parameters were normal in all of the patients. The durations of foreburst revealed significant correlation with the number of reflux episodes and acid exposure time (P = .026 and P = .044, respectively). CONCLUSION: The duration of the foreburst correlating with acid exposure time and number of reflux episodes suggested that foreburst duration was extended because of the irritation caused by the acid reflux.

Determination of the changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue.

The purpose of this study was to determine changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue. This study also attempted to determine the possible relationship between the predictive factors of intubation difficulty by using the intubation difficulty scale, which was introduced by Adnet et al., duration of suspension laryngoscopy and changes in hypoglossal nerve function after suspension laryngoscopy. The study was performed on 39 patients who underwent suspension laryngoscopy for benign glottic pathology. Pre-operative airway assessment was evaluated by the intubation difficulty scale and the duration of suspension laryngoscopy was recorded. Needle electromyography of the tongue was performed three or four weeks after the suspension laryngoscopy. After needle electromyography of the tongue, increased polyphasia was found in 13 patients (33 per cent), bilaterally in three of them. The interference pattern was reduced in two of these 13 patients. There was no statistically significant difference in predictive factors of intubation difficulty and the duration of the operation between these 13 patients with increased polyphasia and the remaining 26 patients with completely normal electromyography findings. These findings show that, in spite of normal clinical tongue function, subclinical changes can be detected by needle electromyography of the tongue after suspension laryngoscopy.

Involuntary movements associated with vitamin B12 deficiency.

Involuntary movements are not a known feature of vitamin B12 (vB12) deficiency in adults, though they are a characteristic feature of vB12 deficiency in infants. This case report presents an adult patient with vB12 deficiency in whom, myoclonus-like muscular contractions appeared soon after the initiation of vB12 and disappeared after the first week of this therapy. To our knowledge, this is the first report of involuntary movements in an adult patient with vB12 deficiency. Although the mechanism remains unknown, involuntary movements similar to myoclonus should be considered as one of the extraordinary neurological manifestations of vB12 deficiency in adults.

[The results of open surgical release in carpal tunnel syndrome and evaluation of follow-up criteria]. / Karpal tünel sendromunda açik cerrahi gevsetme sonuçlari ve takip kriterlerinin karsilastirilmasi.

OBJECTIVES: We evaluated the results of open surgical release in patients with carpal tunnel syndrome (CTS) and assessed the necessity of a clinical scoring system and electromyography (EMG) in the postoperative follow-up. METHODS: The study included 24 wrists of 15 patients (9 females, 6 males; mean age 49.2 years; range 23 to 70 years) in whom a diagnosis of CTS was made by clinical examination and EMG. The patients underwent open surgical release and were followed-up for a mean of 21.5 months (range 7 to 40 months), during which they were evaluated by the Boston scale (BS) for clinical scoring and EMG. Postoperative findings of BS and EMG were compared in terms of their utility during follow-up. RESULTS: Statistically significant differences were found between preoperative and follow-up EMG values of motor distal latency, sensorial latency, combined motor muscle potential amplitudes, and sensorial latency amplitudes (p<0.05). Of twenty-four wrists, 16 (66.6%) showed improvement, and eight (33.3%) showed marked improvement. Similarly, preoperative and follow-up BS scores showed significant differences in favor of treatment results (p<0.05). The Boston scale scores and EMG results were found consistent in showing treatment outcome. CONCLUSION: Open surgical release of CTS provides favorable results that can be sufficiently evaluated by the clinical scoring system alone. Electromyographic studies do not seem to add extra benefits to the postoperative evaluation of patients with CTS.