Tactile directional sensibility and diabetic neuropathy.

Five different procedures used to diagnose neuropathy were compared in a "blind" study with diabetic patients. The aim was to evaluate tests of tactile directional sensibility. Three matched groups were examined, two groups with type I diabetes, either with or without suspected neuropathy, and one of healthy controls. Testing consisted of: (1) examination by a specialist in neurology, (2) electrophysiologic measurement of nerve conduction velocity and determination of cool sensitivity, and (3) determination of directional sensibility in two stages, with categorical and quantitative techniques. Abnormal test results were obtained for both groups of diabetic patients. Quantitatively measured directional sensibility had the highest sensitivity (89%) and specificity (85%) when calculated for patients who had received a diagnosis of neuropathy from the neurologist, despite one case of abnormal directional sensibility among the healthy controls. Conduction velocity testing was almost comparably sensitive (80%) and cool sensitivity, comparably specific (85%) when calculated in the same manner.

Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients.

BACKGROUND AND PURPOSE: A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients. These studies vary in inclusion criteria, sample size, and evaluation methods. The present study was designed to investigate whether electroacupuncture treatment favorably affects stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. METHODS: One hundred four consecutive patients >40 years of age admitted to hospital because of an acute stroke were randomized to 3 groups: deep, superficial, and no acupuncture treatment. The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after randomization and was given twice a week for 10 weeks. All patients underwent conventional stroke rehabilitation as well. Two occupational therapists, blinded regarding the patients' allocation, evaluated the treatment effects. The assessments were performed 4 times during the first year after randomization by means of interviews and observations. RESULTS: There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months. Regarding the Nottingham Health Profile, the no acupuncture group had somewhat fewer mobility problems. No differences in health care and social services were found between the groups. CONCLUSIONS: The present study does not give support to the previous studies, which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services.

[Cerebrospinal fluid cytology--a valuable diagnostic method in various neurologic problems]. / Liquorcytologi--en värdefull diagnostisk metod vid olika neurologiska frågeställningar.

Cytological examination of cerebrospinal fluid can provide vital diagnostic information, particularly in inflammatory and neoplastic disorders of the nervous system. Not only can the cause of a pleocytosis be established but cytological abnormalities can also be detected in cases where the cell count is normal. Monoclonal antibodies can be used for the characterisation of leukaemic cells.

Nerve repair and axonal transport: outgrowth delay and regeneration rate after transection and repair of rabbit hypoglossal nerve.

The axonal transport and distribution of the fast phase of [3H]leucine-labeled proteins were used to monitor the outgrowth delay and regeneration rate in rabbit hypoglossal nerves 5-21 days after crush or transection. The transected nerves were repaired with mesothelial chambers or epineurial sutures. Radiolabeled proteins were transported into regenerating axons in the distal nerve segment after an initial delay of 2.5 days for crushed nerves and after a delay (initial and scar delays) of 4.8 and 5.7 days for sutured and mesothelial chamber-reconnected nerves, respectively. Regeneration rate was 3.5 mm/day after a crush and 2 mm/day after a transection with either type of repair. Total radioactivity was greater in both crushed and repaired nerves than in their contralateral controls. Transported radioactivity accumulated at the site of the lesions. This accumulation was greater and persisted longer in repaired nerves than in crushed ones. The difference in regenerative response after different types of trauma with respect to changes in axonal transport is emphasized.

Nerve repair and axonal transport. Distribution of axonally transported proteins during maturation period in regenerating rabbit hypoglossal nerve.

The distribution of fast migrating [3H]leucine-labelled proteins was studied in transected and repaired rabbit hypoglossal nerves. The nerves were repaired 90 days earlier with mesothelial chamber or epineurial suture technique. Fast migrating radiolabelled proteins were transported into the distal nerve segment and neurophysiological recordings from the tongue as well as the presence of myelinated axons in the distal nerve segment verified successful regeneration. The total amount of radioactivity was increased in repaired nerves as compared to contralateral nerves. In both groups there was a significant accumulation of radiolabelled proteins at the site of lesion. Nerves repaired with mesothelial chambers showed significantly more radioactivity in the distal nerve segment as compared to sutured nerves. The present study indicates long-standing effects on axonal transport system after both types of nerve repair. It is our opinion that axonal transport studies are a valuable complement when evaluating experimental nerve repair.

The effect of ligation combined with section on anterograde axonal transport in rabbit hypoglossal nerve.

The axonal transport of radiolabeled slow phase proteins and fast phase glycoproteins was studied in rabbit hypoglossal nerve one week after axotomy. The nerves were ligated and cut to prevent axonal regeneration into the distal stump. In this situation of obstructed axonal outgrowth, the axonal transport of these components into the proximal part of the nerve was increased. This increase, however, was significantly less pronounced compared with the increase previously found after nerve crush, when the axons were free to regenerate. The results suggest that the axonal transport response concerning structural axonal proteins after nerve lesions depends on the type of trauma, and that the neuronal export of these components during regeneration is modified if axonal outgrowth is impaired. The results are discussed in the light of the present understanding of the role of axonal transport in nerve regeneration.

Slow axonal transport or proteins; blockade by interruption of contact between cell body and axon.

The influence of ligation and colchicine treatment on the axonal transport of slowly migrating [3H]leucine-labelled proteins was studied in the vagus nerve of the rabbit. Two days after [3H]leucine labelling of the dorsal motor nucleus of the vagus nerve, ligation or local application of 60 mM colchicine immediately blocked the further progression of slowly migrating proteins distal to the site of treatment. Application of 50-100 mug colchicine to the nerve cell bodies 2 days after labelling blocked the transport of slowly migrating proteins within the next 24 h. It is suggested that contact between nerve cell body and the axon is necessary for the maintenance of the slow transport of proteins in these nerves.