Comparison of unilateral pallidotomy and subthalamotomy findings in advanced idiopathic Parkinson's disease.

A prospective, randomized, double-blind pilot study to compare the results of stereotactic unilateral pallidotomy and subthalamotomy in advanced idiopathic Parkinson's disease (PD) refractory to medical treatment was designed. Ten consecutive patients (mean age, 58.4 +/- 6.8 years; 7 men, 3 women) with similar characteristics at the duration of disease (mean disease time, 8.4 +/- 3.5 years), disabling motor fluctuations (Hoehn & Yahr stage 3-5 in off-drug phases) and levodopa-induced dyskinesias were selected. All patients had bilateral symptoms and their levodopa equivalent dosing were analysed. Six patients were operated on in the globus pallidus interna (GPi) and four in the subthalamic nucleus (STN). Clinical evaluation included the use of the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn&Yahr score and Schwab England activities of daily living (ADL) score in 'on'- and 'off'-drug conditions before surgery and 6 months after surgery. There was statistically significant improvement in all contralateral major parkinsonian motor signs in all patients followed for 6 months. Levodopa equivalent daily intake was significantly reduced in the STN group. Changes in UPDRS, Hoehn & Yahr and Schwab England ADL scores were similar in both groups. Cognitive functions were unchanged in both groups. Complications were observed in two patients: one had a left homonymous hemianopsia after pallidotomy and another one developed left hemiballistic movements 3 days after subthalamotomy which partly improved within 1 month with Valproate 1000 mg/day. The findings of this study suggest that lesions of the unilateral STN and GPi are equally effective treatment for patients with advanced PD refractory to medical treatment.

Assessment of efficacy and psychomotor performances of thiocolchicoside and tizanidine in patients with acute low back pain.

Objectives of this study were to assess efficacy and effects on psychomotor performances of thiocolchicoside (TCC) and tizanidine (TZ) compared to placebo. Patients complaining of acute low back pain (LBP) associated with muscle spasm were enrolled in this randomised, double-blind clinical trial, comparing the effects of oral TCC, TZ and placebo on psychomotor performances assessed by a visual analogue scale of tiredness, drowsiness, dizziness and alertness and by psychometric tests after 2 and 5-7 days of treatment. The efficacy assessments, both TCC and TZ, were more effective than placebo in improving pain at rest, hand-to-floor distance, Schober test and decreased paracetamol consumption. There were significant differences among the treatment groups in favour of TCC compared to TZ in visual analog scale-parameters. TZ-induced reduction of psychomotor performances of the patients was confirmed by psychometric tests, which showed significant differences among groups. This study showed that TCC is at least as effective as TZ in the treatment of acute LBP, while it appears devoid of any sedative effect in contrast to TZ.

External metallic circle in microsurgical anastomosis of common bile duct.

BACKGROUND: Biliary stricture development is one of the most serious problems following biliary tract surgery. Here, we present a new technique for biliary tract reconstruction with an external metallic circle, and the results of this new technique in a rat model. METHODS: Twelve male Sprague-Dawley rats (250 to 300 g) were divided into two groups. After transection of the bile duct, standard bile duct reconstruction (without the metallic circle) was performed in group 1 and reconstruction with the external metallic (silver) circle was performed in group 2. At the end of the fourth month, clinical, laboratory biochemical, and histopathologic parameters were compared between the groups. RESULTS: Serum concentrations of alkaline phosphatase (ALP) and operation time were higher in group 1 than in group 2. Differences were statistically significant. In histopathologic examination, biliary duct stricture was seen in group 1. Foreign body reaction and fibrosis in the bile duct wall were seen in group 2. CONCLUSION: An external metallic circle prevents development of biliary stricture after primary end-to-end bile duct anastomosis in this rat model.

Long-term effects of extraluminal dilatation with a rigid circle on arteriovenous anastomotic line in venous grafts transposed into arterial defects.

Postanastomotic narrowing resulting from subintimal hyperplasia is a well-known phenomenon. In the current study the authors compared a metallic circle and conventional suture technique in anastomoses performed in two ends of external jugular vein grafts interposed in carotid arteries of rabbits. They recorded the patency rates, fluid flow rates, and histological effects of the circle on the anastomotic line and compared them with conventional suture anastomoses. In 16 rabbits (experimental group) a standard suture was used in both ends of the jugular vein graft transposed to the carotid arteries on one side. On the other side, circle anastomoses were performed on both ends of the vein graft. In an additional 8 rabbits (control group), the anterior jugular veins and carotid arteries were dissected on both sides and left. During postoperative week 12, in 8 rabbits of the experimental group, the flow rates of carotid arteries were measured in vitro, and intraluminal silicone casts were prepared. In the remaining 8 experimental rabbits, carotid angiographies were performed and anastomotic segments were harvested for histological examination. Flow rates were also measured in the control group, and artery and vein segments were harvested. The patency rates of the vein grafts with metallic circle anastomoses were 100%, whereas conventional suture patency was 75% at week 12. Flow rates were significantly higher in the metallic circle-anastomosed vein grafts (74 ml per minute vs. 123 ml per minute, mean values; p < 0.05). Histological examination revealed reduced intimal thickness in the metallic circle anastomoses compared with conventional suture anastomoses. Dilatation of the arteriovenous end-to-end anastomotic line by a rigid circle prevents anastomotic narrowing in the long term.

The 980-nm diode laser as a new stimulant for laser evoked potentials studies.

BACKGROUND AND OBJECTIVE: Lasers have been used as stimulators for creating pain response without stimulating mechanoreceptive fibers. Various laser systems are still under investigation on the quest for best laser system. Our objective was to test the feasibility of the 980-nm diode laser for LEP (laser evoked potentials) studies. STUDY DESIGN/MATERIALS AND METHODS: Laser evoked potentials created by using the 980-nm diode laser were recorded by using standard electroencephalogram (EEG) techniques. The collimated laser beam was 3 mm in diameter. Stimulus duration was set to 200 msec. The power of laser stimulus exposed to the dorsum of the right hand of 10 healthy volunteer subjects (5 women and 5 men) was varied between 0 and 10 watts to determine the pain threshold. EEG signals during the exposure of 1.5 times the threshold value were recorded from scalp electrodes placed on areas Fz, Cz, Pz, C3, and C4 according to the international 10--20 system. The stimulus presented during the EEG recording was described as a bearable pain sensation like a pinprick perception by the subjects. After 0.1--30 Hz analog low-pass filtering, 100-msec prestimulus, and 900-msec poststimulus EEG epochs were recorded at 256 Hz sampling rate and evaluated statistically. Thirty stimuli were presented by randomly varying the interstimulus duration between 5 and 9 seconds. RESULTS: Latency and amplitude values of LEPs were found in accordance with those reported in the literature. CONCLUSION: The 980-nm diode laser used is a suitable stimulator for LEP studies.

End-to-side neurorrhaphies of the ulnar and median nerves at the wrist: report of two cases without sensory or motor improvement.

The authors present two unsuccessful clinical cases of end-to-side neurorrhaphy. In the first patient the distal median nerve was coapted in an end-to-side manner to the intact ulnar nerve. In the other patient four cables of sural nerve graft were used to bridge the ulnar nerve and the intact median nerve by two end-to-side coaptations. Neurorrhaphies were performed via epineural sutures through epineural windows. Both of the cases failed to demonstrate any signs of regeneration either clinically or as evidenced by electromyography, Semmes-Weinstein monofilament test, or 256-Hz vibration tests at 18 and 21 months' follow-up respectively.

Two new intramedullary implant designs for phalanx fixation in digital replantation: an experimental study.

Bone fixation in digital replantation must provide adequate rigidity, and must be applied in a fast and easy manner. Various fixation methods have been used so far with certain advantages and disadvantages. The authors report two new intramedullary proximal phalangeal implant designs to secure two amputated bone segments tightly. They compare their intramedullary implants with commonly applied K-wire fixation methods and plate fixation via biomechanical analysis in terms of bending rigidity and distraction strength. Their two-sided asymmetrical screw provided the highest rigidity and distraction strength, whereas the hook-trap system was nearly equal to cross-K-wire fixation. Intramedullary bone fixation may be a feasible method of bone fixation, and resorbable implant materials and different implant configurations deserve further investigation.

End-to-side microvascular anastomosis using an external metal ring.

Enthusiasm for developing safer and faster anastomotic techniques and complementary devices continues. We report on a new microvascular end-to-side anastomosis technique using a silver ring around the anastomotic circumference. The purpose of this study was to compare the effectiveness of this technique with conventional end-to-side vessel anastomosis. Forty Sprague-Dawley rats were divided into two groups. Twenty rats were used to assess the external ring method in end-to-side anastomosis between carotid arteries and anterior jugular veins and the remaining 20 formed the control group with conventional end-to-end anastomosis. The anastomosis time was 26.4 min for standard suture anastomosis and 18.4 min for the external ring technique (P< 0.01). Patency was 95% with standard technique and 100% using the external ring (P> 0.05). The external ring technique of end-to-side microvascular anastomosis is a safe and reliable method and may reduce the operation time. Its clinical applicability should be further evaluated.

Lymphatic malformation causing intractable chylorrhagia.

Lymphatic malformation is a developmental error usually noticed at birth or in early childhood. Lesions of the upper leg and lower trunk are the most difficult to remove, because they are often the largest ones encountered and also because they tend to extend proximally into the retroperitoneal tissues. Chyle reflux, usually associated with lymphedema of the extremity, has not been reported to be caused by lymphatic malformation. We report a case of intrapelvic retroperitoneal lymphatic malformation with an extension of gluteal-thigh soft-tissue involvement causing intractable chylorrhagia. The tumor was subtotally excised, and the defect was closed by a distally based, peninsular latissimus dorsi myocutaneous flap. The flap served both as a filling material and as a "bridge" between the residual tumor, including abnormal lymphatics, and normal lymph flow.

Human auditory fast and slow omitted stimulus potentials and steady-state responses.

Two kinds of omitted stimulus potentials (OSP) are called "fast" and 'slow." Fast OSPs, recently found with visual stimuli, are here extended to auditory; they occur after omissions or after the end of trains of 1 to > 20 Hz clicks. Slow OSPs, long known, follow trains of 0.3 to 4 Hz. Each has its constant peak latency after the due-time of the first missing stimulus, as though the system is expecting something quite accurately on schedule. They differ in dynamics and slow OSPs require the subject to attend; fast OSPs do not. Steady-state responses (SSR) at a critical click rate of 6-7 Hz sometimes appear to alternate between two forms and OSPs may depend on which they follow. Fast OSPs can occur to the first, second and even the third omissions after the end of a train. Short conditioning periods suffice. Irregular interstimulus intervals do not reduce fast OSPs but attenuate slow OSPs.

A new epineural nerve repair technique: oblique nerve coaptation.

Despite the existence of various nerve coaptation techniques, functional results of nerve repair are still inadequate. Potential benefits of developing modified coaptation techniques cannot be disregarded. The authors report a new coaptation technique in which the nerves are cut in an oblique fashion to increase the coaptational surface. The sciatic nerves of male Wistar albino rats were cut at an angle of 30 and 45 deg (experimental groups), and 90 deg (control group). The nerves were repaired with nine 10-0 epineural stitches. Functional and histological studies were performed at week 12 on 7 rats from the 30-deg group, 15 rats from the 45-deg group, and 7 rats from the 90-deg group. Mean sciatic function index values of walking track analysis were the following: 30-deg group, -42.4+/-15.4; 45-deg group, -44.7+/-17.9; and 90-deg group, -52.9+/-13.9 (p>0.05). The mean values of myelinated axonal counts for the 30-deg, 45-deg, and 90-deg transection groups were 196.2+/-3.7, 196.1+/- 3.7, and 176.1+/- 5.6 respectively for proximal nerve segments and 180.1+/-6.8, 178.2+/-3.8, and 114.1+/-17.3 respectively for distal samples. Both the 30-deg and 45-deg coaptational groups had a significantly lower reduction of myelinated axonal counts at the regeneration zone in comparison with the 90-deg group (p<0.01). Mean myelinated axonal diameters in the proximal nerve segments were 8.2+/-2.6 microm, 8.4+/-3.1 microm, and 8.1+/-3.2 microm respectively, and were 7.1+/-3.6 microm, 6.9+/-3.4 microm, and 6.7+/-3.4 microm respectively in the distal nerve segments (p>0.05). The oblique nerve coaptation technique may enhance nerve regeneration by enabling a larger sprouting and contact area for nerve fibers, but additional investigation by more experienced centers is needed before relying on the preliminary results of this simple modification.

Bartsocas-Papas syndrome with fusion of the lips and posterior fusion defects of the thoracic vertebrae.

Bartsocas-Papas syndrome is a rare popliteal pterygial syndrome with multiple anomalies including microcephaly, facial clefts, filiform bands, ankyloblepharon, syndactyly, and other ectodermal anomalies. Affected infants usually die perinatally. The authors present an 8-month-old female infant with manifestations of this syndrome and some additional traits including fusion of the lips, intraoral filiform bands, alopecia totalis, and posterior fusion failure of the vertebrae. The fused lips were opened by incising the fibrotic bands closing her mouth. Details of this patient and a brief review of the literature is presented.