Twenty-two patients with 25 neural injuries at the elbow joint were reviewed. Follow-up lasted 2 years after surgery. Mean age was 9.4 years. Findings at surgery revealed discontinuity of the affected nerve trunk in eight cases; 17 cases showed a constrictive lesion with the nerve trunk in continuity. Surgical technique involved repair by interfascicular grafting in six lesions, two by epineural suture, and 17 by neurolysis. The mean interval between injury and surgery was 10.1 months (range, 1-40). Motor and sensory function assessment was according to the Nerve Injuries Committee of the British Medical Research Council (preoperatively and at the final follow-up). Excellent results were found in nearly 80% of the continuous lesions treated by neurolysis. In discontinuous lesions, we found 66% with excellent results with grafting. The prognosis after neurolysis in continuous lesions is excellent. In discontinuous lesions after surgery, the rate of recovery is high. There is a poor prognosis for surgery performed > or = 1 year after the injury.

Adolescent↗

PubMedDate not supplied

A sporadic, atypical case of desminopathy: morphological and immunological characterization.

Recently, abnormal expression of cyclin-dependent kinases was proposed as a possible cause of desminopathy. We describe an atypical case clinically characterized by severe respiratory distress. Muscle biopsy showed subsarcolemmal and intracytoplasmic accumulation areas, which intensively stained with anti-desmin antibodies and contained electrondense filamentous material at ultrastructural level. WB analysis showed 30% increased desmin signal compared to controls. Positive immunostain for CDC2 kinase, CDK2 and emerin and nuclear matrix-associated protein were, found in desmin-positive fibres.

Adult↗

PubMedDate not supplied

Sleep-related breathing disorders in amyotrophic lateral sclerosis.

Sleep-related breathing events in patients with amyotrophic lateral sclerosis (ALS) have been reported in small case series, but the association with the clinical presentation--with (B) or without (nonB) bulbar symptoms--or the relevance for prognosis have not been investigated. We retrospectively analyzed sleep studies of 114 (46 nonB) ALS patients, aged 54 +/- 11 years. Respiratory function was better in nonB patients: forced vital capacity was 76 +/- 20% vs 55 +/- 23% in the bulbar group (p < 0.001); PaCO2 41 +/- 5 vs 44 +/- 6 mm Hg p < 0.05. The mean apnea/hypopnea index (AHI) was higher in nonB patients (22 +/- 12 vs 15 +/- 16 events per hour- p < 0.05); in this group 21 out of 46 patients (46%) had more than 20 events/hour versus 14 out of 68 (21%) in the nonB group (p < 0.005). On the contrary the oxygen desaturation index (ODI) was similar (10 +/- 11 vs 9 +/- 12 events per hour, p = NS). Most events had a central genesis and obstructive events were usually erratic, except in 7 patients (6 in group B) who had more than 10 obstructive events/hour. Data were stratified in three groups: with a disease duration below 1 year (< 1 yr), between 1 and 2 years (1-2 yr), and more than 2 years (> 2 yr). The occurrence of sleep-related respiratory disorders decreased with the increase of disease duration (23 +/- 15; 18 +/- 14; and 16 +/- 15 events per hour respectively), the decrease being significantly lower in the > 2 yr group than in the < 1 yr (p < 0.05). Again ODI was similar in the three groups. In conclusion the present study shows that sleep-related breathing events are more common than previously described in ALS patients, particularly in the first year following onset of the disease. Obstructive events occur rarely, although the prevalence of obstructive sleep apnea is higher than predicted, particularly when bulbar symptoms are present. Patients without bulbar signs show a higher prevalence of central events. The progressive decrease of events with the increase of disease duration could be due to a progressive weakness of respiratory muscles, but it could also suggest an independent role for nocturnal events which could be linked to a worse prognosis or to a more rapid decay of clinical status.

Adult↗

PubMedDate not supplied

Changes in nutritional and immunologic parameters after preparation for colonic surgery.

In 15 patients about to undergo colorectal resection for cancer (group I), body weight, lymphocytes, albumin, prealbumin, complement components C3 and C4 and total hemolytic complement activity (TC) were evaluated on admission to hospital and after preroperative preparation which involved dietary restrictions for 5-9 days (450 calories, 25 g protein daily). The same parameters were evaluated in 15 patients admitted for other major surgery not requiring colonic preparation (group II). Statistically significant reduction in prealbumin, C3, C4 and TC were found only in group I. The observations suggest a relationship between immunonutritional status and preparation for large-bowel surgery, reproducing a state of acute malnutrition.

Adult↗

PubMedDate not supplied