Complete Spontaneous Recovery Research Articles

Letters to the Editor

Letters to the Editor

Multidetector Computed Tomographic Angiography in Isolated Third Nerve Palsy

To evaluate whether multidetector computed tomographic angiography (CTA) scanners can detect a clinically significant intracranial aneurysm in the circle of Willis causing an isolated third nerve palsy (ITNP). Retrospective cross-sectional study. One hundred thirty-seven patients who presented with an ITNP were examined by multidetector CTA scanners. All patients whose symptoms were caused by a compressive cerebral aneurysm were identified. The remaining patients were observed clinically to exclude the possibility of a missed cerebral aneurysm causing the ITNP. No patient underwent diagnostic conventional cerebral angiography (CCA), but all patients who underwent treatment underwent CCA at the time of the treatment. Accurate identification of a cerebral aneurysm that may cause an ITNP. A cerebral aneurysm causing an ITNP was detected in 27 patients (19.7%). The smallest maximal diameter of a clinically significant aneurysm was 5.7 mm. Of the 27 patients, 25 underwent endovascular coiling at which time CCA confirmed the aneurysm. In no case was another lesion found by CCA. Of the patients without an aneurysm, 81 of 110 (74%) made a complete spontaneous recovery. In no patient was there clinical evidence to suggest that a compressive cerebral aneurysm had been missed on CTA. Multidetector CTA is a safe and effective diagnostic imaging tool in detecting clinically significant aneurysms when a patient presents with an acute ITNP. We no longer perform CCA to detect a causative aneurysm or determine the type of treatment offered in these patients.

Evaluation of Elbow Flexion as a Predictor of Outcome in Obstetrical Brachial Plexus Palsy

The purpose of this study was to answer two questions. First, are there obstetrical brachial plexus palsy patients with no elbow flexion at 3 months who go on to recover useful upper extremity function without surgical intervention? Second, are there patients with evidence of elbow flexion at 3 months who do benefit from brachial plexus reconstruction? The authors retrospectively reviewed a sample drawn from 253 consecutive patients at The Hospital for Sick Children obstetrical brachial plexus database from 1993 to 1996. Inclusion criteria were examination at age 3 months and either complete spontaneous recovery or repeated examination after age 3 years. Two hundred nine patients satisfied the inclusion criteria. Patients were distributed into four groups: group A, no elbow flexion at age 3 months (operative management); group B, elbow flexion present at 3 months (operative management); group C, no elbow flexion at age 3 months (nonoperative management); and group D, elbow flexion present at 3 months (nonoperative management). Groups A, B, and C showed significant intragroup improvements in both elbow flexion (p < 0.0001) and total limb motion scores (the sum of 15 individual joint motions) (p < 0.0001) with time. No differences were noted among groups A, B, and C for either elbow flexion or total limb motion scores at final follow-up. Early elbow flexion alone is not a sufficient criterion to recommend a nonoperative approach. In addition, spontaneous recovery of useful upper extremity function has been observed in a carefully selected subset of patients without elbow flexion at 3 months.

Surgical Strategies for Brachial Plexus Polio-Like Paralysis

Brachial plexus polio-like paralysis is an acute flaccid paralysis of the upper limb following viral infection. Surgical approaches to the paralytic limb have not previously been discussed in the literature. This study is the first to describe the clinical course and propose a surgical strategy for disabilities related to poliomyelitis-like paralysis. Between 1982 and 2004, 17 patients (11 boys and six girls) presented with acute flaccid paralysis of the upper limb. Their clinical course was reviewed retrospectively. Average age at onset of disease was 2 years (range, 4 months to 13 years). All patients had disability in shoulder abduction and/or elbow flexion. Ten patients underwent reconstructive surgery. Stage V shoulder abduction (>160 degrees) according to Gilbert's classification was regained in five patients who underwent nerve transfer within 1 year of paralysis. One patient treated by nerve transfer after 3 years of paralysis obtained only stage I abduction (<45 degrees). In two patients, multiple local muscle transfers were performed for the shoulder abduction disability, resulting in mild improvement from stage I to stage II abduction (<90 degrees). In four patients, functioning free muscle transplantation for elbow flexion was carried out, and all regained functional M4 muscle strength. Of seven patients in the nonsurgical group, two had complete spontaneous recovery within 1 year, but five had permanent residual limb paralysis at a mean follow-up of 10 years. Surgical strategies, including nerve transfer for shoulder abduction deficit within 1 year after attack and functioning free muscle transplantation for the elbow flexion deficit in the late period, should be considered for this disease. Late reconstruction, either by nerve transfer or by using local multiple muscle transfer for shoulder abduction, is ineffective.

Bupivacaine Induced Cardiac Toxicity Mimicking an Acute Non-ST Segment Elevation Myocardial Infarction

Bupivacaine is widely used as a local anesthetic. Central nervous system (CNS) and cardiovascular toxicity are well known side effects. However, there has been no report of bupivacaine-induced myocardial injury. We present a case of bupivacaine cardiac toxicity mimicking an acute non-ST segment elevation myocardial infarction, which was eventually diagnosed as bupivacaine-induced cardiac toxicity without CNS toxicity. As soon as a healthy young woman at a private clinic was given a spinal anesthesia of 6 mg bupivacaine for hemorrhoidectomy, she developed arrhythmia and hypotension. She was transferred to our emergency room. There was an accelerated idioventricular rhythm with ST segment depression on electrocardiogram, coarse breathing sounds with rales on whole lung field and a butterfly sign on the chest radiograph. 2D transthoracic echocardiography (TTE) revealed reduced left ventricle systolic ejection fraction (approximately 27%). There was regional wall motion abnormality of the left ventricle on 2D TTE and the cardiac marker was increased. We diagnosed the patient as having acute non-ST segment elevation myocardial infarction but her impaired cardiac function improved gradually. On the seventh day from admission, there was a complete spontaneous recovery of cardiac function, and coronary angiography revealed a normal coronary artery. Therefore, we firmly believe that bupivacaine directly injures the cardiac cell.

Hipertensión arterial episódica asociada al síndrome de taquicardia postural ortostática

We report the case of a 17-year-old woman who presented to the emergency department on several occasions due to palpitations, tachycardia, syncope, short spells of dizziness and light-headedness with complete spontaneous recovery, and hypertension. The patient had been evaluated by several specialists, and multiple complementary examinations had revealed no abnormalities that could explain the symptoms. Due to suspicion of orthostatic intolerance or postural orthostatic tachycardia syndrome with hypertension, the patient underwent a 60-degree tilt table test, which confirmed the diagnosis. The patient was successfully treated with bisoprolol. The physiopathological mechanisms, diagnosis, and treatment of this syndrome are reviewed.

Time course of action of sugammadex (Org 25969) on rocuronium-induced block in the Rhesus monkey, using a simple model of equilibration of complex formation

Reversal of neuromuscular block can be accomplished by chemical encapsulation of rocuronium by sugammadex (Org 25969), a synthetic gamma-cyclodextrin derivative. The present study determined the time course of the reversal action of sugammadex on rocuronium-induced block in the anaesthetized Rhesus monkey using train-of-four stimulation. A bolus injection of rocuronium 100 microg kg(-1) (about 1xED(90)) was given to determine the degree of neuromuscular block reached by this dose. After complete spontaneous recovery, a rapid bolus injection of sugammadex, 1 mg kg(-1), was given and at different time intervals (15, 30 or 60 min, in three different experiments) the effect of another rocuronium bolus injection of 100 microg kg(-1) was determined. Injection of the first dose of rocuronium resulted in a mean neuromuscular block (depression of first twitch) of 93 (SEM=1.6)%. Fifteen minutes after injection of sugammadex the same rocuronium dose resulted in 17% (SEM=5.6) block. After 30 and 60 min these maximum blocks amounted to 49% (SEM=7.6) and 79% (SEM=4.2), respectively. The estimated half-life of sugammadex in Rhesus monkey is 30 (SEM=4.9) min. The half-life of sugammadex (Org 25969), a new fast and efficient reversal agent for rocuronium-induced block, is relatively short in the Rhesus monkey, implying the possibility to perform neuromuscular block by rocuronium shortly after reversal of a prior block. In translation to the human situation differences in rocuronium sensitivity and kinetics should be taken into account.

Onset and duration of mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy

To determine the response to mivacurium, we prospectively studied onset time and complete spontaneous recovery from mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy (DMD). Twelve boys with DMD, age 5-14 yr, seven of them wheelchair-bound, ASA II-III, and 12 age- and sex-matched controls (ASA I) were enrolled in the study. Anaesthesia was induced with fentanyl 2-3 microg kg(-1) and propofol 3-4 mg kg(-1) titrated to effect, and maintained by continuous i.v. infusion of propofol 8-12 mg kg(-1) and remifentanil as required. The lungs were ventilated with oxygen in air. Neuromuscular transmission was assessed by acceleromyography using train-of-four (TOF) stimulation every 15 s. After baseline readings, a single dose of mivacurium 0.2 mg kg(-1) was given. The following variables were recorded: (i) lag time; (ii) onset time; (iii) peak effect; (iv) recovery of first twitch from the TOF response to 10, 25 and 90% (T(10), T(25), T(90)) relative to baseline; (v) recovery index (time between 25 and 75% recovery of first twitch); and (vi) recovery time (time between 25% recovery of first twitch and recovery of TOF ratio to 90%). For comparison between the groups the Mann-Whitney U-test was applied. There were no differences between the groups in lag time, onset time and peak effect. However, all recorded recovery indices were significantly (P<0.05) prolonged in the DMD group. The median (range) for time points T(10), T(25) and T(90) in the DMD and control group was 12.0 (8-16) vs 8.4 (5-15) min, 14.1 (9-20) vs 10.5 (7-17) min and 26.9 (15-40) vs 15.9 (12-23) min, respectively. The recovery index and recovery time were similarly prolonged in the DMD group. These results support the assumption that mivacurium-induced neuromuscular block is prolonged in patients with DMD.

Spontaneous complete recovery of paraplegia caused by epidural hematoma complicating epidural anesthesia: a case report and review of literature

Case report. Tertiary referral spinal surgery center in South India. To report a patient who developed epidural hematoma following epidural anesthesia causing acute paraplegia. Surgery was avoided due to concomitant gastrointestinal bleeding and poor general condition. Patient showed early signs of recovery with complete resolution of neurological deficits in 12 weeks. Surgery can be avoided in patients who show early signs of neurological recovery following epidural hematoma.

“Stokes-Adams Epilepsy”

HomeCirculationVol. 112, No. 8“Stokes-Adams Epilepsy” Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUB“Stokes-Adams Epilepsy”Sometimes We Need the Electroencephalogram Óscar Díaz-Castro, MD, Pedro Orizaola, MD, Sofía Vázquez, MD, Carina González-Ríos, MD, Mónica Pardo, MD, Jesus A. Fernández-Lopez, MD and Dolores Escriche, MD Óscar Díaz-CastroÓscar Díaz-Castro From the Cardiology Service (O.D.C., S.V., C.G.R., M.P., J.F.L.), Neurology Service (D.E.), and Neurophysiology Service (P.O.), Hospital do Meixoeiro. Vigo, Pontevedra, Spain. Search for more papers by this author , Pedro OrizaolaPedro Orizaola From the Cardiology Service (O.D.C., S.V., C.G.R., M.P., J.F.L.), Neurology Service (D.E.), and Neurophysiology Service (P.O.), Hospital do Meixoeiro. Vigo, Pontevedra, Spain. Search for more papers by this author , Sofía VázquezSofía Vázquez From the Cardiology Service (O.D.C., S.V., C.G.R., M.P., J.F.L.), Neurology Service (D.E.), and Neurophysiology Service (P.O.), Hospital do Meixoeiro. Vigo, Pontevedra, Spain. Search for more papers by this author , Carina González-RíosCarina González-Ríos From the Cardiology Service (O.D.C., S.V., C.G.R., M.P., J.F.L.), Neurology Service (D.E.), and Neurophysiology Service (P.O.), Hospital do Meixoeiro. Vigo, Pontevedra, Spain. Search for more papers by this author , Mónica PardoMónica Pardo From the Cardiology Service (O.D.C., S.V., C.G.R., M.P., J.F.L.), Neurology Service (D.E.), and Neurophysiology Service (P.O.), Hospital do Meixoeiro. Vigo, Pontevedra, Spain. Search for more papers by this author , Jesus A. Fernández-LopezJesus A. Fernández-Lopez From the Cardiology Service (O.D.C., S.V., C.G.R., M.P., J.F.L.), Neurology Service (D.E.), and Neurophysiology Service (P.O.), Hospital do Meixoeiro. Vigo, Pontevedra, Spain. Search for more papers by this author and Dolores EscricheDolores Escriche From the Cardiology Service (O.D.C., S.V., C.G.R., M.P., J.F.L.), Neurology Service (D.E.), and Neurophysiology Service (P.O.), Hospital do Meixoeiro. Vigo, Pontevedra, Spain. Search for more papers by this author Originally published23 Aug 2005https://doi.org/10.1161/CIRCULATIONAHA.104.503144Circulation. 2005;112:e101–e102A 72-year-old woman was admitted to the neurology service. She complained of recurrent episodes of a sudden loss of consciousness followed by “seizures” lasting 1 or 2 minutes with complete spontaneous recovery after a few seconds. The patient had suffered 5 or 6 episodes per day in the previous week. The history revealed 1 episode of intracranial hemorrhage without sequelae 6 months before. The ECG showed normal sinus rhythm with normal PR interval and QRS length. The patient was treated with phenytoin, but the “attack” recurred. An EEG was performed and during the scan, the patient suffered a new episode of loss of consciousness followed by generalized rigidity, spasmodic movements, and oculocephalic deviation. The episode lasted 15 seconds, followed by rapid and complete recovery. The EEG showed a prolonged (12 seconds) ventricular asystole (arrow) resulting from paroxysmal AV block (Figure 1), followed by a series of sharp waves initially on the left temporary region (Figure 2) with quick secondary generalization in form of slow waves of high voltage mingled with tips and sharp waves (*). Later on, depression of general voltage took place (#), followed by progressive recovery of the base rhythm (Figure 3). After a permanent pacemaker was implanted, the patient never suffered the “seizures” again. Download figureDownload PowerPointFigure 1. EEG and ECG showing the beginning of the asystole resulting from paroxismal AV block (arrow).Download figureDownload PowerPointFigure 2. EEG after 12 seconds of asystole. Generalized slow waves of high voltage mingled with tip and sharp waves (∗) and progressive depression of general voltage (#).Download figureDownload PowerPointFigure 3. EEG showing complete recovery of the base rhythm once the cardiac rhythm was normal.FootnotesCorrespondence to Dr Óscar Díaz-Castro, S. de Cardiologia. 5a Planta Centro, Hospital do Meixoeiro, O Meixoeiro sn CP:36200, Vigo, Pontevedra. Spain. E-mail [email protected] or [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Izumi M, Okabe T, Komura M and Hayashi Y (2018) Reply to “The electroencephalogram in syncope”, Journal of General and Family Medicine, 10.1002/jgf2.217, 19:6, (227-227), Online publication date: 1-Nov-2018. Izumi M, Okabe T, Komura M and Hayashi Y (2018) Convulsive syncope on electroencephalogram, Journal of General and Family Medicine, 10.1002/jgf2.165, 19:3, (109-110), Online publication date: 1-May-2018. Benton T and Narayanan D (2015) Differentiating Seizure and Convulsive Syncope: The Importance of History Taking, Postgraduate Medicine, 10.3810/pgm.2008.04.1760, 120:1, (50-53), Online publication date: 1-Jan-2008. CAIRE-HERRERA L, GOMEZ-FIGUEROA E, CERVANTES-URIBE R, ROSAS-GUTIERREZ R, MORENO-AVELLAN Á and FERNÁNDEZ M (2020) Convulsive syncope: a Stokes-Adams case, Arquivos de Neuro-Psiquiatria, 10.1590/0004-282x20200019, 78:8, (523-524) August 23, 2005Vol 112, Issue 8 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.104.503144PMID: 16116059 Originally publishedAugust 23, 2005 PDF download Advertisement SubjectsArrhythmiasDiagnostic TestingImagingPacemaker

Acute Pyloric Spasm and Gastric Hypomotility: An Extracardiac Adverse Effect of Percutaneous Radiofrequency Ablation for Atrial Fibrillation

This study sought to describe a new adverse effect of percutaneous radiofrequency (RF) ablation for atrial fibrillation (AF). Extension of the RF lesion beyond atrial myocardium may affect mediastinal structures other than the esophagus. Circular mapping-guided isolation of the pulmonary veins was performed in two different electrophysiology laboratories, either individually and supplemented by ostial and posterior left atrial (LA) ablation or two by two with a series of ostial and posterior LA lesions. The RF energy was delivered point by point through a 5-mm open-tip irrigated catheter (40 W maximum) or an 8-mm-tip catheter (45 W maximum). In four (two in each electrophysiology laboratory) of 367 patients undergoing catheter ablation for AF, abdominal pain and distension developed within 48 h after the procedure. Investigation showed acute pyloric spasm and gastric hypomotility, probably the result of LA endocardially delivered RF affecting the periesophageal vagi. Complete spontaneous recovery occurred in two patients, but laparoscopic esophagojejunal anastomosis and endoscopic intra-pyloric Botulinum toxin injection, respectively, were performed to remedy delayed gastric emptying in two patients. Thermal injury during endocardial LA RF energy delivery may extend into the mediastinum and rarely may involve the periesophageal nerves, resulting in a syndrome of acute delayed gastric emptying. Marked anatomic variability of periesophageal vagi renders it difficult to reliably avoid the area overlying this plexus, therefore, we advocate a reduction in maximum RF power and application duration on all of the posterior LA to try to avoid this complication.

Onset and Duration of Rocuronium-induced Neuromuscular Blockade in Patients with Duchenne Muscular Dystrophy

In patients with Duchenne muscular dystrophy (DMD) the response to nondepolarizing muscle relaxants is scarcely documented and conflicting. The current study was conducted to determine the time to peak effect and the time for complete spontaneous recovery after a single dose of 0.6 mg/kg of rocuronium in patients with DMD. Twenty-four patients (12 with DMD, 12 controls, aged 10-16 yr) were studied. All patients were anesthetized with propofol and fentanyl/remifentanil. Neuromuscular transmission was monitored by acceleromyography. After induction all patients received a single dose of 0.6 mg/kg of rocuronium. The complete time course of onset and spontaneous recovery were recorded Significant (P < 0.01) increase in the onset times to 95% neuromuscular block was observed in DMD patients (median, 203 s; range, 90-420 s) compared with controls (median, 90 s; range, 60-195 s). The time between rocuronium administration and recovery of first twitch of the train-of-four to 90% was significantly (P < 0.01) prolonged in DMD compared with controls (median, 132 min; range, 61-209 min versus 39 min; 22-55 min). The recovery index was also significantly prolonged in the DMD group compared with controls (median, 28 min, range, 15-70 min versus 8 min; 3-14 min). The most striking and surprising result of this study is the delayed onset of blockade in DMD after a standard dose of rocuronium. This effect should be kept in mind in situations when a rapid airway protection is necessary in DMD patients. The documented very long recovery from rocuronium-induced block emphasizes the need for careful assessment of neuromuscular function in DMD patients.

Pfannenstiel versus Vertical Laparotomy in Patients Undergoing Radical Retropubic Prostatectomy with Spinal Anesthesia: Results of a Prospective, Randomized Trial

Objective: To evaluate the impact of a standard vertical laparotomy versus a Pfannenstiel transverse laparotomy on intra-, peri-operative, and 6-month follow-up outcome in patients undergoing radical retropubic prostatectomy with pelvic lymphadenectomy with spinal anesthesia. Methods: Between January 2003 and June 2003, 69 age-matched consecutive patients with clinically localized prostate cancer underwent radical retropubic prostatectomy with pelvic lymphadenectomy with spinal anesthesia and were randomized into Group 1 (vertical laparotomy: 35 patients) and Group 2 (Pfannenstiel laparotomy: 34 patients). An extensive analysis of the critical intra-, peri-operative, and 6-month follow-up clinical parameters was performed. Results: Both the hemodynamics and the biochemical balance were not significantly different between the two groups. Overall blood loss ( p = 0.78), autologous ( p = 0.88) and homologous ( p = 0.36) blood transfusions were similar regardless of the type of laparotomy. Surgical time was not significantly ( p = 0.27) different between the two groups. Similarly, the two forms of laparotomy did not differ regarding the length of the surgical incision ( p = 0.21), as measured at the end of the procedure. Post-operative oxygen saturation percentage by pulse oximetry, as well as post-op sedation score, were not significantly different ( p = 0.06 and p = 0.97, respectively). Waiting time in the post-operative holding area ( p = 0.15), and pain score in the post-operative holding area ( p = 0.9) as well as on post-operative day 1 ( p = 0.1) were not significantly different between the two groups. The rate of first flatus passage and of unassisted ambulation were similar regardless of the type of laparotomy during post-operative day day 1. The two types of incision made it possible to remove a similar ( p = 0.34) number of pelvic lymph nodes and were associated to a similar rate of positive surgical margins among pT2 patients. At the 6-month follow-up the occurrence of a pelvic lymphocele and of deep venous thrombosis was similar in the two groups ( p = 0.6 and p = 0.16, respectively). Complete urinary continence and spontaneous erectile function recovery was reported in a similar number of patients regardless of the type of surgical incision ( p = 0.59 and p = 0.40, respectively). Conclusions: These results suggest that a Pfannenstiel transverse suprapubic laparotomy does not result in a significantly different outcome from a standard vertical laparotomy in patients undergoing a radical retropubic prostatectomy with pelvic lymphadenectomy with L2–L3 spinal anesthesia for clinically localized prostate cancer.

Conduite à tenir devant une diarrhée aiguë. Étiologies

Acute diarrheas are a common disease, and their high frequency constitutes an important problem in terms of public health. Most of the time, they have an infectious origin and spontaneous complete recovery is achieved within less than three days. In practice, history of diarrhea, physical examination and environmental identification are the main points for selecting patients who will need medical explorations. Only 1% of patients need immediate laboratory complementary investigations, i.e., stool analysis, either because their symptomatology indicates potential underlying acute colitis (bloody stools, localized abdominal pain), or when there is an underlying frail condition associated with an immediate risk for the patient, or in case of a particular context such a stay in a tropical area. The practitioner has to inform the biologist on all symptoms and relevant information so as to optimize the analysis and its cost-effectiveness. Until the laboratory results are available, such selected patients require antibiotic treatment (quinolones). These investigations are also needed in case of >3-day persistent diarrhea. When stool samples are free of bacteria or parasite, and when acute diarrhea persists more than 5 days, a specialist should be visited. Thus, only a small proportion of patients with acute diarrhea will undergo endoscopy, probably cases of colitis or recto colitis. Early re-hydration remains the preferential treatment of acute diarrhea in children since, for more than two decades, it has demonstrated its efficacy in reducing mortality, particularly in developing countries.

Cardiologie fœtale

Syncope belongs to the transient loss of consciousness (TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of emergency department visits.Recurrent syncope can seriously affect children's physical and mental health, learning ability and quality of life and sometimes cardiac syncope even poses a risk of sudden death. The present guideline for the diagnosis and treatment of syncope in children and adolescents was developed for guiding a better clinical management of pediatric syncope. Based on the globally recent development and the evidence-based data in China, 2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents was jointly prepared by the Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association (CMA)/Committee on Pediatric Syncope, Pediatricians Branch, Chinese Medical Doctor Association (CMDA)/Committee on Pediatric Cardiology, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association (CMDA)/Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association (BMA). The present guideline includes the underlying diseases of syncope in children and adolescents, the diagnostic procedures, methodology and clinical significance of standing test and head-up tilt test, the clinical diagnosis vasovagal syncope, postural orthostatic tachycardia syndrome, orthostatic hypotension and orthostatic hypertension, and the treatment of syncope as well as follow-up.

Chronic cognitive effects of bilateral subdural haematomas in the rat

Humans suffering from subdural haematomas often show long-term cognitive dysfunctions. For identifying putative, recovery-enhancing therapeutics, animal models need to be developed in which recovery of function can be measured. For investigating whether and which type of recovery, i.e. spontaneous or training-induced recovery, or continuous partial retardation, is present in the rat model for bilateral subdural haematomas, spatial navigation abilities were assessed in the Morris water escape task in independent groups of rats at 1, 2, 4, 8, or 18 weeks after surgery. Complete spontaneous recovery seemed to occur at 8 weeks after injury. However, at 18 weeks after injury, the subdural haematoma caused a renewed deterioration of water maze performance, which was of a lesser degree than the impairments observed immediately after injury. This second phase performance deterioration was accompanied by an increase in generalised astrocyte reactivity. The rat subdural haematoma model provides an interesting tool for investigating spontaneous recovery processes of spatial navigation (8 weeks after injury), but also for progressive brain dysfunctions, considering the second phase of behavioural impairments seen at 18 weeks after injury.

Memory for extinction of conditioned fear is long-lasting and persists following spontaneous recovery.

Conditioned fear responses to a tone paired with footshock rapidly extinguish when the tone is presented in the absence of the shock. Rather than erase conditioning, extinction is thought to involve the formation of new memory. In support of this, extinguished freezing spontaneously recovers with the passage of time. It is not known, however, how long extinction memory lasts or whether extinction interferes with consolidation of conditioning if given on the same day. To address this, we gave rats 7 trials of auditory fear conditioning followed 1 h later by 20 extinction trials, and tested for spontaneous recovery after a delay of 0, 1, 2, 4, 6, 10, or 14 d. Conditioned freezing to the tone gradually recovered with time to reach 100% by day 10. No-extinction controls indicated that the increase in freezing with time was not owing to incubation of conditioning memory. Complete spontaneous recovery indicates that extinction training given 1 h after conditioning does not interfere with the consolidation of conditioning memory. Despite complete recovery of freezing, rats showed savings in their rate of re-extinction, indicating persistence of extinction memory. These data support the idea that conditioning and extinction of fear are learned by independent systems, each able to retain a long-term memory.

Quadriceps paresis in pediatric groin surgery.

A total of 2,624 groin operations were performed in 2,202 infants and children aged 6 months-14 years during the last 4.5 years. Preventive analgesia was used in all operations, and included ilioinguinal and iliohypogastric nerve block combined with inguinal canal infiltration. In 6 patients transient postoperative quadriceps muscle paresis (QMP) was noted. They required bed rest and monitoring for a few hours, and complete spontaneous recovery was noted in all cases. The aim of this study was to examine the incidence of transient QMP following regional nerve block and to discuss models of possible prevention.

Síndrome mieloproliferativa transitória associada à trissomia do 21 e fibrose hepática

Neonates with Down's Syndrome (DS) occasionally show an excess of blast cells in their peripheral blood and bone marrow. The leukocyte counts are high and just the evolution can discriminate the diagnosis of Transient Myeloproliferative Disorder (TMD) from acute myelogenous leukemia (AML). In contrast to AML, complete spontaneous recovery takes place within 4 - 8 weeks. Liver dysfunction and fibrosis have a major prognostic impact. The aim of this work is to relate the case of a child with TMD, DS and hepatic fibrosis. A male infant with characteristic findings of DS, hepatosplenomegaly and cardiac murmur was examined. The white blood cell count was 95,000/mm³, 19% blast cells, platelets 170,000/mm³, total bilirubin 35.86 mg/dL, AST 184 UI and ALT 122 UI. The echocardiogram showed total atrial-ventricular septal defect, pulmonary hypertension and patent ductus arteriosus. The serology proved to be negative and a hepatic biopsy showed colestasis, sinusoidal and portal fibrosis and immature myeloid elements. The leukocyte count diminished, the platelet count remained low and the liver function worsened. The patient received anti-neoplastic treatment with daunorubicin and cytarabine on the 50th day of life. He later developed pneumonia and renal failure and died on the 61st day. The natural history of TMD raises intriguing questions regarding its origin, clinical course and the subsequent development of leukemia. Liver fibrosis may have a major prognostic impact. It has been reported that 6 out of 8 cases of TMD with hepatic dysfunction died, and liver fibrosis associated with extramedullary hematopoiesis was found in 4 cases. The hypothesis is that liver fibrosis could be caused by cytokines produced by the megakaryocytes in the liver.

The outcome of Erb's palsy when the decision to operate is made at 4 months of age.

Since the establishment of the obstetrical brachial plexus clinic in Saudi Arabia, the author has designed a prospective study in which the indication for brachial plexus surgery in infants with Erb's palsy was the lack of active elbow flexion against gravity at 4 months of age. Forty-three infants were included in the study and were distributed among four groups: group A (n = 20) included infants who had active elbow flexion at the initial assessment or at 2 months of age; group B (n = 9) included infants who had active elbow flexion at 3 months of age; group C (n = 11) included infants who had active elbow flexion at 4 months of age; and group D (n = 3) included infants who did not have active elbow flexion at 4 months of age. At the final follow-up, all children in group A demonstrated complete spontaneous recovery of the motor power of the limb. All children in group B also had satisfactory spontaneous recoveries, and none required secondary corrective procedures. Five of the 11 patients in group C had satisfactory spontaneous recoveries. The remaining six children in group C had good recovery of elbow flexion but a poor recovers of shoulder function. Finally, all three patients who did not have elbow flexion at 4 months of age (group D) underwent surgical exploration and reconstruction of the brachial plexus, using nerve grafts. The results of this prospective study are discussed, along with the controversial issue regarding the timing of primary plexus surgery in Erb's palsy.