[The value of electroneurography in recognition of peripheral ischaemic polyneuropathy in patients suffering from critical leg ischaemia]. / Wartosc badan EMG w rozpoznaniu polineuropatii niedokrwiennej u chorych z krytycznym niedokrwieniem konczyn dolnych.

Peripheral arteries disorders cause not only leg ischaemia, but also peripheral polyneuropathy. Polyneuropathy increases ischaemic pain. The aim of this study was to estimate how many patients suffering from critical leg ischaemia have symptoms of peripheral polyneuropathy. 40 patients were investigated: 37 men and 3 women; mean age was 57 years. All patients underwent electroneurographic examination. It consisted of measurements of motor conduction in tibial and peroneal nerves, wave F, sensory conduction in sural nerve. Polyneuropathy was observed in 95% of patients. The frequency of polyneuropathy was also significantly enlarged in leg with non critical ischaemia. We did not observe the greater risk of polyneuropathy in diabetic patients. The work is an introduction to the following clinical studies.

[Transcranial Doppler ultrasonography and hyperventilation test in assessment of cerebral vasoreactivity after ischemic stroke]. / Ocena reaktywnosci naczyn oporowych u pacjentów po udarze niedokrwiennym mózgu przy uzyciu przezczaszkowej ultrasonografii dopplerowskiej i testu hiperwentylacji. (Doniesienie wstepne).

In 36 patients 3 month after ischaemic stroke in regions supplied by MCA (Middle Cerebral Artery) physical examination, CT scanning and blood flow velocity recordings in ICA (Internal Carotid Artery) and MCA were performed. In both MCA blood flow velocity was measured in resting state and after 30 sec. of hyperventillation. The control group consisted of 40 healthy volunteers. In the control group blood flow decrease after hyperventillation was nearly equal in both hemispheres (38% in right and 37% in the left hemisphere). In studied group in the symptomatic hemisphere blood flow reduction was 21%. Vasoreactivity in the opposite hemisphere was similar to that in control group (35% decrease). The results suggest that vasoreactivity diminution is a local phenomenon limited to the infarcted area. Hyperventilation test, despite its simplicity, seems to be sufficient for screening vasoreativity.

[Clinico-electrophysiological image and the results of the treatment of Isaacs-Mertens syndrome]. / Obraz kliniczno-elektrofizjologiczny i wyniki leczenia zespolu Isaacsa-Mertensa.

A case of Isaacs-Mertens syndrome is reported in which the predominating clinical symptom was muscular rigidity. Characteristic bioelectric activity was recorded in resting muscles. Good response was observed after diphenylhydantoin.

[2 cases of ischemic cerebral stroke in a young man with hyperlipidemia type IV]. / Dwa niedokrwienne udary mózgu u mlodego mezczyzny z hyperlipidemia typu IV.

In a young man at the age of 29 and 35 years without risk factors for atherosclerosis and, consequently, cerebrovascular disease two severe strokes of atypical clinical pattern developed leading to considerable impairment of psychomotor fitness. Diagnostic tests and study of family members demonstrated familial hyperlipidaemia type IV.

[Results of prospective 24-hour EEG studies of patients after cranio-cerebral injuries]. / Wyniki prospektywnych 24-godzinnych badan EEG u chorych po urazie czaszkowo-mózgowym.

In 26 patients 24-hour cassette EEG recording and routine EEG records were taken between 6 and 35 days and again between 6 and 12 months after craniocerebral trauma. Neurological examination and CT of the head demonstrated cerebral concussion in 11 cases and brain contusion in 15 cases. Early after trauma routine EEG was abnormal in 5 cases (19.2%) exclusively in those with brain contusion, and 24-hour EEG recording was abnormal in 16 cases (61.5%), including 7 with cerebral concussion and 9 with brain contusion. In the second half year after trauma 24-hour EEG was normal in 5 cases (19.2%) which had previously abnormal records, and abnormal EEG changes appeared in 6 cases (23.1%) with previously normal findings. Seizure activity was found in the first weeks after trauma in 9 (34.6%) 24-hour recordings. In the second half year after trauma seizure activity was no longer present in 2 cases, but appeared in 6 other cases. Thus 24-hour recording between 6 and 12 months after trauma demonstrated seizure activity in 50% of all patients. In 2 of them epileptic fits developed. The study shows that repeated 24-hour EEG recording after craniocerebral trauma may be important in early detection of patients who are at risk of epilepsy development.

[24-hour monitoring of bioelectric activity of the brain in patients after cranial injuries]. / 24-godzinne monitorowanie czynnosci bioelektrycznej mózgu u chorych po urazach czaszki.

In patients after craniocerebral trauma 24-hour EEG and routine EEG records were obtained. 44 cases were studied between 6 and 38 days after trauma and 45 cases were examined between 6 and 12 months after trauma. The diagnosis of brain commotion in early phase based on neurological examination and computed tomography was made in 22 cases, while in 22 cases late posttraumatic phase was diagnosed. Brain contusion in early and late phase was diagnosed in 22 and 23 cases, respectively. Early after craniocerebral trauma the study demonstrated changes in routine EEG in 8 cases (18.1%), while 24-hour EEG demonstrated them in 26 cases (59.0%), that is three times more as frequently. Changes in 24-hour EEG were found nearly twice as frequently than in routine EEG 6-12 months after trauma (51.0% and 28.9% respectively). In patients with brain commotion in the first week after trauma only 24-hours EEG revealed changes. Late after trauma 24-hour EEG could demonstrate seizure activity more frequently than routine EEG.

[Value of the studies of multimodal evoked potentials for evaluation of neurotoxic effects of combined exposure to lead, copper and zinc]. / Wartosc badan multimodalnych potencjalów wywolanych dla oceny neurotoksycznego wplywu mieszanego narazenia na olów, miedz i cynk.

Central nervous system dysfunction was studied in workers with occupational exposure to Pb+Cu+Zn by measuring somatosensory evoked potentials of short and long latency, visual evoked potentials and brain-stem evoked auditory potentials. The tests were done in 40 workers with a history of exposure from 6 to 19 (mean 14.3) years in a copper foundry. Pb poisoning was not diagnosed in them, but 18 workers had some abnormalities of heme synthesis. Pb concentration in blood was from 11.4 to 62.8 (mean 35.7) mcg% in the whole group. Pb concentration in air in the foundry exceeded 1.1-175 times the MAC value, the concentration of CU exceeded it 7.25 times. Zn concentration was half the MAC value. No significant abnormalities were found in the parameters of multimodal evoked potentials. The obtained data suggest a protective effect of copper and zinc on heme , Pb blood level and conduction velocity of somatosensory, visual and auditory impulses in workers exposed to high Pb air concentration.

[Multimodal evoked potentials in the early period after cranio-cerebral trauma]. / Multimodalne potencjaly wywolane we wczesnym okresie po urazie czaszkowo-mózgowym.

In 83 patients aged 17-68 years somatosensory evoked potentials by median nerve stimulation, and visual and auditory evoked potentials were studied 5-28 days after craniocerebral trauma. Brain concussion was diagnoses in 43 cases on the basis of neurological examination, CT and duration of unconsciousness. In the remaining 40 cases brain contusion was diagnosed. In SSEP the latency was calculated of waves N9, N13, P16, N20, P22, N35 and P40: in the visual evoked potentials the latency of the P100 component, and in auditory evoked potential the latency of waves I, III and V, and interpeak latency I-III, III-V and I-V SSEP changes were found in 39% of cases of brain concussion and 52.9% of brain contusion cases. The abnormalities in both groups involved mainly the component of latency and deviation P100 of visual evoked potential P40 and N35. Prolongation of the latency of P100 of the visual evoked potential was recorded in 20% of patients with brain concussion and 16.7% with brain contusion. Auditory evoked potentials were abnormal in 10.3% of brain concussion and 26.5% of brain contusion cases. In 64 cases all three types of evoked potentials were studied and pathological changes in at least one of these types were found in 56.4% of brain concussion and 72% of brain contusion cases. The results show that as least in a part of cases diagnosed as brain concussion according to generally accepted criteria, central nervous system injury is present.

[Prospective studies of multimodal evoked potentials in patients after cranio-cerebral injury]. / Prospektywne badania multimodalnych potencjalów wywolanych u chorych po urazie czaszkowo-mózgowym.

In 42 patients aged 18-68 years somatosensory, visual and brainstem auditory evoked potentials were studied in the first month after trauma and after 6-8 months after craniocerebral trauma for evaluation of their diagnostic importance in less severe craniocerebral trauma. On the basis of the results of neurological examination, CT of the head, and duration of unconsciousness in 22 cases brain concussion and in 20 cases brain contusion was diagnosed. In patients after brain concussion the frequency of early and late abnormalities after head trauma was as follows: for SSEP 36.4% and 27.3% respectively, for visual evoked potentials 21.1% and 5.3%, for auditory potentials 9.5% and 4.8%. In cases of brain contusion abnormalities were found in the 1st month and 6-8 months after trauma in SSEP in 60% and 20% respectively, in visual EP in 11.1% and 22.2%, and in auditory EP in 30% and 40%. In the group of concussion the greatest and most persistent changes developed in the later components od SSEP. Among certain patients with brain contusion deterioration of the results of visual and auditory evoked potentials were noted late after trauma.

[Value of multimodal evoked potentials in the assessment of the neurotoxic effects of carbon disulphide]. / Przydatnosc badan multimodalnych potencjalów wywolanych w ocenie neurotoksycznego wplywu dwusiarczku wegla.

Central nervous system dysfunction among CS2-exposed workers was studied by measuring short latency SSEPs and VEPs. The examinations were done in 40 men. Chronic CS2 intoxication was diagnosed in 21 of them. Latency of N19, N11, N20 of somatosensory evoked potentials and latency of P100 wave of visual evoked potentials were statistically significant longer in CS2 exposed group in comparison with controls. The amplitude of N20 SSEPs was also significantly higher. Increase of N20 amplitude (33 persons) and elongation of its latency (25 persons) were frequent abnormalities of SSEps. In individual assessment of VEPs, most frequent were: abnormal difference in interocular latency of P100 (26 persons) and elongation of P100 latency (25 persons). In the analysed SSEPs and VEPs parameters there was no significant difference between two clinical groups. The authors conclude that the CS2--neurotoxic effect leads to impairment of the peripheral and central part of the somatosensory pathway, as well as to central dysfunction of the visual pathway.

Visually evoked potentials and simple reaction times to visual stimuli in chronic disulphide intoxication.

The relationship between parameters of visually evoked potentials (VEPs) and the results of a psychological test assessing the speed of motor reaction to visual stimuli was examined in 21 patients with chronic carbon disulphide intoxication. Correlations obtained suggest cerebral disfunction of the visual pathway and diminished ability to transform visual information to motor reaction at the level of the cortical association centre.

Multimodality evoked potentials in occupational exposure to metallic mercury vapour.

Central nervous system dysfunction among workers exposed to metallic mercury was studied by measuring somatosensory evoked potentials (SSEPs) and visual evoked potentials (VEPs). The examinations were conducted in 28 workers suspected of chronic mercury intoxication. They were exposed to Hg for a period ranging from 4-34 years (mean 22.1) in an acetic aldehyde and chlorine manufacturing plant. The increase of amplitude of N20 SSEP (13 cases) and elongation of its latency were frequent abnormalities in the examined group. The latency of N20 was significantly longer in the exposed group in comparison with the control one, the amplitude of N20 was also significantly higher. Significantly prolonged latency of P100 VEP was found in the group exposed to Hg. These findings suggest the possibility of an adverse effect due to Hg on the central part of the somatosensory and visual pathway.

[Visual evoked potentials and the time of motor reaction to visual stimuli in chronic metallic mercury poisoning]. / Wzrokowe potencjaly wywolane i szybkosc reakcji ruchowych na bodzce wzrokowe w przewleklym zatruciu rtecia metaliczna.

In a group of 10 patients with diagnosed occupational chronic poisoning with metallic mercury a correlation was sought between the parameters of the visual evoked potentials and the results of the psychological test evaluating the rapidity of motor response to the visual stimuli. The analysis suggest a cerebral dysfunction of the visual neurons and reduced rate of visual information transformation to the motor effector at the level of the cortical association centre.

[Porphyria variegata--a case report]. / Porfiria pstra--opis przypadku.

In a man aged 28 years abdominal pains with constipation appeared, and were followed after 2 weeks by generalized maximal epileptic seizures, gradually progressing signs of proximal polyneuropathy, numerous brownish patches on the face and trunk, and hepatomegaly. In the urine raised levels were found of delta aminolaevulinic acid, prophobilinogen, coproporphyrins and uroporphyrins. Examination of stools demonstrated an increase of protoporphyrins and coproporphyrins, with prevalence of the former, characteristic of porphyria variegata. A gradual regression of changes was observed after treatment with high doses of propranolol and intravenous glucose infusions.

[Treatment of Guillain-Barré syndrome by the method of fractionated plasma exchange with controlled hemodilution]. / Leczenie zespolu Guillaina-Barrego metoda frakcjonowanej wymiany osocza w hemodilucji sterowanej.

Plasma exchange under controlled haemodilution was tried in 9 patients with Guillain-Barré syndrome repeating the procedure at 24-hour intervals for from 7 to 17 times with a total exchange of plasma ranging from 2.0 to 4.9 litres. All patients had significant paresis or paralysis of all four extremities, and 3 had additionally respiratory failure. The criteria accepted for performing plasmapheresis included a very severe form of the disease and a steady progression of signs despite treatment with corticosteroids. Already after the first exchange of plasma arrest of disease progression was observed in all cases, and after the 2nd or 3rd exchange a progressing improvement began. Six patients regained the ability of walking within 4 to 8 weeks, all were discharged walking unaided. The obtained results suggest the conclusion that the therapeutic method used is a very effective way of treating severe cases of Guillain-Barré syndrome and should be used in these patients.

[Conduction in the motor fibers of the ulnar nerve in cut-glass workers]. / Przewodzenie we wlóknach ruchowych nerwu lokciowego u zdobników szkla krysztalowego.

The authors have estimated the motor conduction velocity of ulnar nerve motor fibres in 39 glass-cutters suspected to neuropathy originating from work performance. The conduction has been checked in two segments; wrist-elbow and below-above elbow (peripheral) and sulcus segments). Twenty-nine workers exhibited reduced conduction; in the sulcus segment--13-fold, in the peripheral segment--4-fold, and in both segments--12-fold. The nerve impairment was greater on the left side, especially in the sulcus segment. After 4 to 24 months another investigation was performed in 22 persons--10 carrying on the work and 12-who had abandoned it. The former group exhibited the impairment, whereas the latter--both improvement and progression. The authors suggest that an appropriate evaluation of the ulnar nerve lesion in glass-cutters but also people representing other professions causing the nerve pressure calls for an investigation of the conduction in the sulcus and peripheral segments.

[Mental development of the children of epileptic mothers]. / Rozwój umyslowy potomstwa matek chorych na padaczke.

In a group of 152 children of epileptic mothers mental deterioration was recognized in 8,5% of cases, that is four times more frequently than in the general population. Children showing evidence of mental retardation were more frequently products of pregnancy during which their mothers had epileptic seizures and were taking drugs. An evident correlation between the intelligence level of the mothers and their children and the efficiency of different psychic functions in both groups suggest a possible role of a genetic factor.