The Erasmus MC modifications to the (revised) Nottingham Sensory Assessment: a reliable somatosensory assessment measure for patients with intracranial disorders.

OBJECTIVE: To investigate the intra-rater and inter-rater reliability of the Erasmus MC modifications to the Nottingham Sensory Assessment (EmNSA). SUBJECTS: A consecutive sample of 18 inpatients, with a mean age of 57.7 years, diagnosed with an intracranial disorder and referred for physiotherapy. SETTING: The inpatient neurology and neurosurgery wards of a university hospital. DESIGN: Through discussions between four experienced neurophysiotherapists, the testing procedures of the revised Nottingham Sensory Assessment were further standardized. Subsequently, the intra-rater and inter-rater reliabilities of the EmNSA were investigated. RESULTS: The intra-rater reliability of the tactile sensations, sharp blunt discrimination and the proprioception items of the EmNSA were generally good to excellent for both raters with a range of weighted kappa coefficients between 0.58 and 1.00. Likewise the inter-rater reliabilities of these items were predominantly good to excellent with a range of weighted kappa coefficients between 0.46 and 1.00. An exception was the two-point discrimination that had a poor to good reliability, with the range for intra-rater reliability of 0.11-0.63 and for inter-rater reliability -0.10-0.66. CONCLUSION: The EmNSA is a reliable screening tool to evaluate primary somatosensory impairments in neurological and neurosurgical inpatients with intracranial disorders. Further research is necessary to consolidate these results and establish the validity and responsiveness of the Erasmus MC modifications to the NSA.

Histochemical and cytochemical studies of metastasizing carcinoma of Bartholin's gland.

A case of adenocarcinoma of Bartholin's glands in a middle aged female is presented. This well known, but rather uncommon malignancy is reported since it shows an unusual structure consisting of a combination of two different histological entities, namely an adeno-cystic component and adenopapillary component. An interval of 21 years elapsed between the appearance of the primary lesion and the recurrence which showed extensive haematogenous and lymphogenous metastases and proved fatal within two years of the recurrence. The study includes an enzyme histochemical evaluation and a fine needle cytological examination. The former revealed a high degree of activity of the NADP+ regenerating enzymes of the pentose shunt as well as a definite, but variable, activity of many lysosomal enzymes, mainly non specific esterases, acid phosphatase, aryl sulphatase and beta-glucuronidase. In contrast to other adenocarcinomas arising in the female genital tract, especially those of endometrium and ovary, the tumour cells showed only a slight activity of alkaline phosphatase, As is the case in many other adenocarcinomas, the activity of lactate dehydrogenase was strongly evident.