Radial nerve palsy: If in doubt, use ultrasound.

Sonographic demonstration of radial nerve compression by a strict permanent suture, with intra-operative correlation.

Circadian and state-dependent core body temperature in people with spinal cord injury.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To analyze the circadian rhythm and state-dependent modulation of core body temperature (Tcore) in individuals with spinal cord injury (SCI) under controlled environmental conditions. SETTING: Institute of the Neurological Sciences of Bologna, Italy. METHODS: We assessed 48-h rectal Tcore and sleep-wake cycle by means of video-polygraphic recording in five cervical SCI (cSCI), seven thoracic SCI (tSCI), and seven healthy controls under controlled environmental conditions. RESULTS: cSCI showed higher night-time Tcore values with reduced nocturnal decrease, higher MESOR and earlier acrophase compared with tSCI and controls (p < 0.05 in all comparisons). The mean Tcore values during wake and non-rapid eye movement (NREM) and rapid eye movement (REM) sleep stages were higher in cSCI compared with tSCI and controls (p < 0.05). Tcore variability throughout the 24 h differed significantly between cSCI, tSCI, and controls. CONCLUSIONS: cSCI had higher Tcore values without physiological night-time fall compared with controls and tSCI, and a disrupted Tcore circadian rhythm. Furthermore, SCI individuals did not display the physiological state-dependent Tcore modulation. The disconnection of the sympathetic nervous system from its central control caused by the SCI could affect thermoregulation including Tcore modulation during sleep. It is also possible that the reduced representation of deep sleep in people with SCI impairs such ability. Further studies are necessary to evaluate whether improvement of sleep could ameliorate thermoregulation and vice versa.

Recovery of laryngeal nerve function with sugammadex after rocuronium-induced profound neuromuscular block.

STUDY OBJECTIVE: The aim of this study was to evaluate the efficacy of sugammadex in reversing profound rocuronium-induced neuromuscular block at the laryngeal adductor muscles using motor-evoked potentials (mMEPs). DESIGN: A prospective observational study. SETTING: University surgical center. PATIENTS: Twenty patients with American Society of Anesthesiologists physical class I-II status who underwent propofol-remifentanil anesthesia for the surgery of the thyroid gland. INTERVENTIONS: Patients were enrolled for reversal of profound neuromuscular block (sugammadex 16 mg/kg, 3 minutes after rocuronium 1.2 mg/kg). To prevent laryngeal nerve injury during the surgical procedures, all patients underwent neurophysiologic monitoring using mMEPs from vocal muscles. At the same time, the registration of TOF-Watch acceleromyograph at the adductor pollicis muscle response to ulnar nerve stimulation was performed; recovery was defined as a train-of-four (TOF) ratio ≥0.9. MEASUREMENT AND MAIN RESULTS: After injection of 16 mg/kg of sugammadex, the mean time to recovery of the basal mMEPs response at the laryngeal adductor muscles was 70 ± 18.2 seconds. The mean time to recovery of the TOF ratio to 0.9 was 118 ± 80 seconds. In the postoperative period, 12 patients received follow-up evaluation of the vocal cords and no lesions caused by the surface laryngeal electrode during electrophysiological monitoring were noted. CONCLUSIONS: Recovery from profound rocuronium-induced block on the larynx is fast and complete with sugammadex. In urgent scenarios, "early" extubation can be performed, even with a TOF ratio ≤0.9. However, all procedures to prevent postoperative residual curarization should still be immediately undertaken.

Ischemia-hyperpnea test is useful to detect patients with fibromyalgia syndrome.

OBJECTIVE: To demonstrate the prevalence of neuromuscular hyperexcitability in Fibromyalgia Syndrome (FMS) by electromyography ischaemia-hyperpnea test (IHT) and its correlation with clinical and clinimetric parameters. MATERIAL AND METHODS: One hundred and forty-five FMS patients underwent IHT to evaluate neuromuscular hyperexcitability and were evaluated for pain (numeric Rating Scale and Regional Pain Scale), tenderness (tender points), disability [Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ)], quality of life (QOL) [Short Form 36 (SF36)], mood [Hospital Anxiety and Depression Scale (HADS)], sleep [numeric rating scale (NRS)], and fatigue [Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT)]. RESULTS: Of the 145 patients, 95 were tested positive by IHT, and 33 and 17 patients were negative and borderline, respectively. By comparing the three groups, IHT positive patients had lower age and lower SF36 vitality (V), social activities (SA), and mental summary index (MSI) than negative patients (p<0.05). By comparing positive versus negative patients and by comparing positive and borderline patients versus negative patients, it was found that FACIT was higher, whereas age, SF36 V, SA, mental health (MH), and MSI were lower (p<0.05). CONCLUSION: FMS patients present a high prevalence of neuromuscular hyperexcitability, as assessed by IHT. IHT positive patients have poor QOL and higher fatigue than IHT negative patients. Thus, IHT positivity could identify FMS patients with a more severe disease.

A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study.

In carpal tunnel syndrome (CTS), manual therapy interventions (MTI) reduce tissue adhesion and increase wrist mobility. We evaluated the efficacy of a MTI in relieving CTS signs and symptoms. Twenty-two CTS patients (pts) (41 hands) were treated with a MTI, consisting in 6 treatments (2/week for 3 weeks) of soft tissues of wrist and hands and of carpal bones. Pts were assessed for hand sensitivity, paresthesia, hand strength, hand and forearm pain, night awakening; Phalen test, thenar eminence hypotrophy and Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Median nerve was studied by sensory nerve conduction velocity (SNCV) and distal motor latency (DML). CTS was scored as minimal, mild, medium, severe and extreme. We considered as control group the same pts assessed before treatment: at baseline (T0a) and after 12 weeks (T0b). Pts were evaluated at the end of treatment (T1) and after 24-week (T2) follow-up. At T0b, versus T0a, forearm pain and Phalen test positivity were increased and hand strength reduced (p < 0.05). BCTQ-SSS and BCTQ-FSS scores improved at T1 versus T0b (p < 0.05) with the amelioration maintained at T2. At T1, the number of pts with paresthesia, night awakening, hypoesthesia, Phalen test, hand strength reduction and hand sensitivity was reduced with the lacking of symptoms maintained at T2 (p < 0.05). No changes in SNCV, DML and CTS scoring were shown. MTI improved CTS signs and symptoms, with benefits maintained at follow-up. Thus, it may be valid as a conservative therapy.

Diagnosis and therapy for neurogenic bladder dysfunctions in multiple sclerosis patients.

Neurogenic lower urinary tract dysfunctions are common in patients with multiple sclerosis and for most of them urinary dysfunction has the most negative impact on their social life. No correlation exists between clinical urinary symptoms and urodynamic patterns. Abnormal urodynamic patterns may be present in asymptomatic patients. Both clinical and urodynamic findings may change during the course of the illness. Early diagnostic approach and scheduled follow-ups are mandatory in order to prevent upper urinary tract complications and improve quality of life (QoL).

Long-term evolution of anti-ganglioside antibody levels in patient with chronic dysimmune neuropathy under IVIg therapy.

The authors retrospectively examined the anti-ganglioside antibody (AGA) IgM level changes from 14 patients with chronic dysimmune neuropathy (5 with multifocal motor neuropathy and 9 with chronic inflammatory demyelinating polyneuropathy) treated with maintenance doses of intravenous immunoglobulins (IVIg). The median follow-up was 5 years. At last follow-up, 93% of the patients had an increment of AGA levels, and five patients with initial AGA values within normal range became positive during follow-up. Overall, median AGA titers significantly increased from the first to the last samples, despite a substantial clinical stability after the initial improvement with IVIg. The AGA increment rate was inversely correlated with IVIg infusions interval necessary to maintain therapeutic efficacy. Thus, antibody testing in the follow-up of patients with dysimmune neuropathies may be helpful to predict the decline of IVIg efficacy and to identify those patients who eventually take advantage from an increase in infusion frequency.

Proposal of a new criterion for electrodiagnosis of meralgia paresthetica by evoked potentials.

We examined 19 subjects with meralgia paresthetica (bilateral in three cases), recording bilateral somatosensory-evoked potentials (SSEPs) after stimulation of the tibial posterior nerve (TPN) and cutaneous stimulation in the region of the lateral femoral cutaneous nerve (LFCN). We calculated the difference between TPN SSEPs and LFCN SSEPs cortical potentials, identifying a temporal parameter that we termed D(SEP). We defined D(SEP) normal values in a control group. D(SEP) evaluation showed good sensitivity and specificity (85.7% and 82.4%, respectively; accuracy, 83.3%) in discriminating affected limbs from unaffected. The main advantage of this method is to disengage from the necessity of contralateral comparison of LFCN recordings, joined with a reduction of interindividual variability of LFCN SSEPs amplitude and latency that often causes a lower sensitivity of other methods. As an interesting consideration, D(SEP) evaluation appears to mark out a possible subclinical involvement of LFCN in the asymptomatic side of patients with meralgia paresthetica.

Sporadic amyotrophic lateral sclerosis as an infectious disease: a possible role of cyanobacteria?

The available epidemiological data for amyotrophic lateral sclerosis (ALS) support an infectious etiology and lead us to propose a new hypothesis. We examined older epidemiological data concerning categories of the population with increased incidence (aged people, people living in rural areas, farmers, breeders), more recent epidemiological reports regarding Italian soccer players, AIDS patients, people living in highly polluted areas, and reports of cases of conjugal and pregnancy-associated ALS. The toxic and infectious hypotheses lead us to suggest a role for cyanobacteria in the production of endogenous beta-N-methylamino-L-alanine. Infection from a cyanobacterium, or another ubiquitous bacterium having similar characteristics, may be the missing clue to the etiology of ALS. We speculate that ubiquitous bacteria secreting toxic amino acids and "colonizing" tissues and organs in the human body might be the common element linking motor neuron diseases in Guam to sporadic ALS in the rest of the world.

Psychobiological correlates of delayed ejaculation in male patients with sexual dysfunctions.

The pathogenesis of delayed ejaculation (DE) is rather unknown, though the contribution of various psychological, marital, hormonal, and neurological factors has been advocated. In this study we systematically investigated the relative relevance of the aforementioned factors in 1,632 men who were seeking medical help for sexual dysfunction. The severity of DE was classified according to Kaplan criteria. Mild and moderate forms of DE (MMDE) recognized different risk factors than the most severe ones (anejaculation or severe DE [ASDE]). ASDE was essentially coupled with the presence of neurological diseases or with the use of serotoninergic drugs. Serotoninergic drugs also significantly increase (by at least 10-fold) the risk for MMDE, which, however, was also coupled with other relational factors (eg, partner's impaired climax, patient's hypoactive sexual desire [HSD]) or intrapsychic factors (eg, stress at work). At multiple regression analysis, some organic pathological conditions (such as psychiatric disorders and hypogonadism) were also associated with MMDE. In particular, hypogonadism retained significance for DE even after adjustment for HSD (adjusted odds ratio = 2.08 [1.11-3.89]; P < .05), suggesting other effects of testosterone deficiency on the ejaculatory reflex besides reduced libido. In conclusion, the present study demonstrates that multiple psychobiological determinants are associated with DE, a still obscure condition that substantially impairs psychosexual equilibrium of the couple.