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PubMed1992

Paraneoplastic paralysis in a patient with malignant fibrous histiocytoma.

A patient presented with lower limb paralysis and a large malignant fibrous histiocytoma (MFH) on her back. Metastatic disease to the spine was excluded and the diagnosis of paraneoplastic paralysis was made. This may be the first described case of a neuromyopathic paraneoplastic syndrome in malignant fibrous histiocytoma. Tissue culture and electron microscopy assisted in establishing the diagnosis of the tumour. A hitherto unrecognised endocrine factor may account for the hypokalaemia which was a feature in this patient.

Aged↗
PubMed1992

[Sarcoidosis as a cause of paralysis of the recurrent laryngeal nerve. Presentation of a case].

A patient with Sarcoidosis presented with hoarseness in the course of the disease, caused by mediastinal adenopathies compressing the left recurrent laryngeal nerve. Vocal cord paralysis is an unusual complication of sarcoidosis. We have found in the consulted worldwide bibliography on the subject only four cases of sarcoidosis with mediastinal enlarged lymph nodes causing compression of the left recurrent nerve and subsequently vocal paralysis.

Humans↗
PubMed2003

[Thyreotoxic periodic paralysis. A cause of pseudo-paralysing hypokalemia that should not be ignored in Caucasians].

INTRODUCTION: Despite its rare occurrence in Caucasians, thyreotoxic periodic paralysis should be evoked in young male Caucasians presenting with episodes of pseudo-paralytic hypokalemia. OBSERVATION: A 37 year-old Caucasian was admitted in intensive care for an acute episode of hypotonic tetraplegia and hypokalemia during which laboratory tests revealed hyperthyroidism due to Basedow's disease. The clinical course was rapidly favourable after a small dose of intravenous potassium. Antithyroid treatment avoided any new occurrence of similar episodes. DISCUSSION: In Caucasians, sporadic acute paralysis with hypokalemia requires testing for hyperthyroidism. Though it is well know that hypokalemia results from potassium intracellular shift, the underlying mechanism remains poorly elucidated. Treatment includes potassium administration with caution and/or beta blockers but the specific treatment is that of hyperthyroidism.

Adult↗
PubMedDate not supplied

[Palliative surgical treatment of spastic paralysis in the lower extremity].

AIMS: The purpose of this paper is to describe our experience with and to review the best results in the surgical treatment of patients suffering from spastic paralysis of the lower limbs. DEVELOPMENT: To enable a correct indication of the techniques to be employed the authors recommend a thorough examination of the types of deformity (fixed, dynamic or mixed) and the use of specific tests for exploring the different deformities. These are necessary steps to be able to interpret the different disorders in a global manner and thus reach diagnostics that provide us with a proper surgical therapeutic orientation about the spastic hip, knee, ankle and foot. Due to the importance of the overall problem, it is becoming increasingly more frequent to advise multidisciplinary work involving the collaboration of different specialists (neurologists, rehabilitators, physiotherapists, psychologists, paediatricians, neurophysiologists and orthopaedic surgeons). Spasticity is as heterogeneous as the results of the different treatment projects. The techniques used must allow the rehabilitation therapy to be continued. Surgical intervention is recommended when the damage to the CNS has stabilised and the patient is over 4 years old. The psychic state of the patient and the family must also be evaluated. CONCLUSIONS: The objective of the treatment in patients who can walk is to improve motor functioning, the type of gait and to prevent fixed deformities from developing. In patients who do not walk, the aim is to improve their hygiene and their capacity to sit and to walk. These indications are indispensable to be able to successfully perform a little-known area of orthopaedic surgery which does not respond to the techniques used in flaccid paralysis surgery.

Humans↗
PubMed2002

[Study on the therapeutic effect of combined use of obidoxime and atropine with respiratory machine on respiratory muscle paralysis caused by omethoate poisoning of rats].

OBJECTIVE: To examine the therapeutic effect of combined use of obidoxime and atropine with artificial ventilation on respiratory muscle paralysis caused by omethoate poisoning in rats. METHODS: Rats were exposed to 2 times the dose of LD50 omethoate and treated with atropine (10 mg/kg) to counteract cholinergic symptoms. When the rats' respiratory frequency became slower and breathed with difficulty, the trachea intubation and artificial ventilation was carried out. The rats in group A were continuously treated with atropine. The dose of obidoxime for Group B, C and D were 8, 15, 20 mg/kg respectively, given at the same time as artificial ventilation and 1, 2, 3 hours later. The doses of atropine was reduced to 1/3 - 2/3 of the first dose so as to maintain the rats atropinized. If the rat survival was beyond 60 minutes after withdrawal of artificial ventilation, the combined treatment was considered successful. The function of isolated phrenic diaphragm of the rats was observed with MS-302 physiological and pharmacological analysis instrument. RESULTS: None of the rats in Group A was successful after withdrawal from artificial ventilation and the function of phrenic diaphragm appeared poor; whereas > 80% of the rats in B, C, D Group were successful after withdrawal from artificial ventilation in 3 h and the function of phrenic diaphragm remained well. The survival rate in B, C and D groups were higher after withdrawal from artificial ventilation than that in Group A(P < 0.01). The function of phrenic diaphragm in Group B, C and D were gradually decreased after ACh was added into the container. CONCLUSIONS: Combined use of suitable dose of obidoxime and atropine with artificial ventilation for respiratory muscle paralysis caused by omethoate poisoning could promote the recovery of diaphragm function and reduce the death rate in poisoned rats.

Animals↗
PubMed1992

[Treatment of central facial nerve paralysis with electromyography biofeedback and taping of cheek. A controlled clinical trial].

We studied 35 patients with facial palsy after stroke, admitted to a rehabilitation hospital. We examined the patients on admission and after one, two and six months with 1) clinical evaluation of the facial function using a modified House-Brackmann scale, 2) photographs of patients with six different facial expressions; these photos were evaluated by "blinded" observers using the modified House-Brackmann scale, 3) questionnaire about patients emotional reactions to the facial paralysis and 4) facial sensation. No differences were found between a control group of 12 and a group of patients (23) training facial function 2-3 times a week, each session of 15 minutes, with EMG-biofeedback and cheek taped between training sessions. A significant improvement in facial function occurred spontaneously after one month in rehabilitation unit in the total group. After six months 2/3 of the patients had normal facial function or mild dysfunction. Patients with right-sided facial palsy showed a significantly better improvement at six months as compared to patients with left-sided facial palsy. The questionnaire showed that only half of the patients were aware of the asymmetric face. We cannot recommend training with EMG-biofeedback to patients with facial paralysis after stroke. Spontaneous remission is to be expected.

Bandages↗
PubMed2003

[CO2 laser endoscopic subtotal arytenoidectomy for bilateral median vocal cord paralysis].

OBJECTIVE: To delineate the surgical procedures and correlated techniques for endoscopic subtotal arytenoidectomy, as well as to discuss their applications and clinical outcomes. METHODS: CO2 Laser endoscopic unilateral arytenoidectomy was performed in eight cases of bilateral median vocal cord paralysis combined with one stage of mucosal micro-anastomosis. All patients suffered from dyspnea in some extent, of which 5 had the history of thyroidectomy and 2 had traumatic causes following esophagectomy and tracheal surgery respectively. One of patient had unknown cause. Six patients had undergone tracheotomy prior to operation or before their referral to our hospital. The airway was evaluated via fibro-optic laryngoscopy, and the voice quality was assessed subjectively by the patients and the surgeon before and after surgery. RESULTS: Following 5-43 months after the surgery, in all cases the function of airway as well as the acceptable voice quality was successfully restored. The tracheotomy done before operation in six patients was decannulated within the mean time of 44.2 days post-operation. CONCLUSION: The endoscopic approach for CO2 laser unilateral arytenoidectomy may lead to better restoration of an adequate airway and satisfying phonation without postoperative aspiration. Mucosal micro-anastomosis can prevent the formation of granulation or scar tissue thus promotes the healing processes. This procedure is simpler than other ordinary surgical methods, and could be a satisfactory alternation of treatment for bilateral median vocal cord paralysis.

Aged↗
PubMed2003

Surgical intervention in traumatic facial nerve paralysis.

A four years review from June 1998 to June 2002 of traumatic facial nerve paralysis from temporal bone fractures that required surgical intervention is presented. The aim of this clinical presentation was to determine the current pattern of cases with traumatic facial paralysis which required surgical intervention at our center. There were six cases, of which four (66%) were longitudinal fractures, one each (17%) had transverse fracture and fracture over the lateral wall of mastoid. Hearing loss (83%) was the commonest associated clinical symptom. All cases underwent decompression via the transmastoid surgical approach. Intraoperative findings revealed oedema of facial nerve involving vertical segment and horizontal segment in three cases each respectively. Two cases had concomitant bony impingement. The facial nerve functions in four cases (66%) and one case recovered to House Brackmann grade 2 and 4, 12 months and 3 months respectively postsurgery. The case with transverse fracture remained as House Brackmann grade 5 after two years.

Adolescent↗
PubMed2004

[Effects of aminoguanidine on the expression of NOS in facial nerve and surrounding tissues of traumatic facial paralysis rats].

OBJECTIVE: To study the effects of inducible NOS inhibitor aminoguanidine on the expression of NOS in facial nerve and surrounding tissue of traumatic facial paralysis rats. METHODS: A small dose of aminoguanidine were intraperitoneally injected into rats before and after facial paralysis. The facial nerve and surrounding tissues were cut at different time point. Immunohistochemical ABC method was used to study the changes of NOS expression in facial nerve and surrounding tissues. RESULTS: The inducible NOS immunoreactivity was obvious inhibited in the facial nerve and surrounding tissues in aminoguanidine group. CONCLUSION: Aminoguanidine chronic treatment can obvious inhibit the inducible NOS expression in the facial nerve and surrounding tissues. Aminoguanidine can improve the regeneration of facial nerve and the recovery of traumatic tissues.

Animals↗
PubMed2004

[Thyrotoxic hypokalaemic periodic paralysis in a Caucasian male].

We report the case of a caucasian patient with a presentation of a periodic paralysis associated with hypokalaemia disclosing Graves' disease. Major pathophysiologics hypothesis are discused in order to explain relationships between hyperthyroidism and paralysis through a disturbance of the excitability of the muscle fibres. A genetic predisposition explain the high incidence of this affection in asiatic population while it is uncommon in caucasian race. Potassium supplementation is not needed in order to correct hypokalaemia except in case of cardiac disturbances. Treatment by beta-blockers is advisable with the specific treatment of hyperthyroidism.

Adrenergic beta-Antagonists↗
PubMed2004

Prevention and management of bilateral vocal cord paralysis by and after thyroid surgery.

Following the great tradition established in the Szent Rókus Hospital and Institutions by author's predecessor Prof. Aurel Réthi, there have been more than 300 patients operated on for treatment of laryngotracheal stenosis. The vast majority of the cases referred to the department suffering from bilateral vocal cord paralysis were the consequences of thyroid surgery and its complications. Confronted with this challenging clinical scenario, the author became determined to focus not only on reconstruction but also on prevention. For example, all thyreoidectomies are performed with identification and preservation of the recurrent nerves. As the author's department is a center for laryngotracheal reconstruction, patients from different institutions were treated with larynx dilating operations, benefiting from the newly developed additional techniques. With the goal of refining alternatives to previous glottis dilating operations, new methods have been worked out for the management of bilateral vocal cord paralysis based on our endo-extralaryngeal suture technique. These recently popularized approaches consist of two operations, an irreversible one and a reversible one. The first operation is performed on patients whose vocal cords are paralyzed. This irreversible operation can be performed with and without arytenoidectomy. These operations were successful in 94 out of 99 patients. The second operation was the reversible endo-extralaryngeal lateralization, which was carried out in 63 patients, 61 of which were successful. In the reversible technique the suture was not removed if the cords remained paralyzed. If there was evidence of return of vocal cord function, the suture was removed, thus eliminating the need for further dilating operations. The author feels that these two operations are quite successful because the medial mucous membrane of the vocal cord is preserved, avoiding scar and granuloma formation. The operations may be performed without any kind of tracheostomy. These are significant advantages over most other glottic dilating operations.

Adolescent↗
PubMed2004

Lewis and Clark treat a case of paralysis: speculation on the etiology of the problem.

In their monumental journey across North America and back, the explorers Lewis and Clark encountered and treated a Native American Chief with flaccid paralysis of about five years duration. The etiology of the paralysis is unclear from the historical sources. Intracranial, spinal cord, neuropathic, neuromuscular and muscular diagnoses are possible. The diagnosis that appears best to fit the case, however, is conversion disorder. In spite of limited diagnostic and treatment resources, the unfortunate man was apparently treated successfully.

Conversion Disorder↗
PubMed2004

[From gene to diseases; hypokalemic periodic paralysis].

Hypokalaemic periodic paralysis is an autosomal, dominantly inherited disorder, characterised by attacks of partial or total muscle weakness and serum hypokalaemia. the mutations responsible are located in the CACNA1S gene (type 1) and in the SCN4A gene (type 2), and are all missense mutations where arginine is mostly replaced by histidine or sometimes glycine. The mutation has been localised in the voltage sensor of the transmembrane segment of calcium channel (type 1) and sodium channel (type 2) respectively. How muscle weakness develops is not known. Oral or intravenous administration of potassium is helpful in treating partial or complete attacks. Acetazolamide can reduce the frequency of attacks in type-1 hypokalaemic periodic paralysis.

Acetazolamide↗
PubMed2004

[Functional assessment of posterior cordotomy in patients with bilateral vocal fold paralysis].

UNLABELLED: Surgical treatment of bilateral vocal fold paralysis must be undertaken if such a condition lasts 6-12 months or longer and causes dyspnoea. The purpose of the procedures is to assure proper airflow through the glottis and to preserve good voice and unimpaired swallowing. Modern endoscopic surgery of the glottis is performed with CO2 laser. The following paper presents results of laser posterior cordotomy performed in 17 patients aged 19-73 years suffering from bilateral vocal fold paralysis. RESULTS AND CONCLUSIONS: In 7 patients the range of vocal fold resection had to be expanded. 3 individuals developed post-operative granulation in subglottal region. Spirometry and electroglottography were performed before and after the operation to assess the patients' laryngeal functions: respiration and voice quality. The results indicate that laser cordectomy was effective in the discussed group of patients.

Adult↗
PubMed2004

Diaphragmatic plication in adult patients with diaphragm paralysis after cardiac surgery.

OBJECTIVE: We investigated the benefit of diaphragmatic plication for weaning from mechanical ventilation in these adult patients. PATIENTS AND METHODS: Four patients underwent diaphragmatic plication for difficulty of weaning from mechanical ventilation due to diaphragmatic paralysis. They were all men with an average age of 70.5 +/- 6.3 years. Three of the patients had undergone cardiac surgeries for coronary artery bypass grafting and one patient ascending aortic replacement for pseudoaneurysm after coronary revascularization. Right diaphragmatic plication (muscle sparing procedure) was performed between 30 to 61 days after cardiac surgery. RESULTS: The mean forced tidal volume improved dramatically from 216 to 415 ml after plication in all patients, and it was possible to discontinue mechanical ventilation from 2 to 12 days after plication. One patient with obstructive respiratory dysfunction died from aspiration pneumonia 15 days after plication. However, postoperative tidal volume in this patient improved to 420 ml and he was able to be weaned from ventilatory support five days after plication. The other three patients were discharged between 26 to 58 days after plication and continue to do well without symptoms. CONCLUSION: Diaphragmatic plication is a useful procedure for treatment of diaphragmatic paralysis in adults as well in children.

Aged↗
PubMed2004

[Comprehensive prognostic value of spontaneous and evoked electromyography in laryngeal paralysis].

OBJECTIVE: To determine the comprehensive prognostic value of spontaneous and evoked electromyography (EMG) in laryngeal paralysis. METHODS: The characteristics of laryngeal EMG of 91 cases with unilateral vocal cord paralysis (VCP) after thyroid surgery were assessed. All cases were divided into four groups according to the interval of laryngeal EMG after onset, which were group one (2 months shorter, n = 13), group two (2 to 4 months, n = 23), group three (4 to 6 months, n = 36), group four (6 months longer, n = 19). The waveform morphology and the amplitude of laryngeal EMG and the highest evoked compound muscular active potential (CMAP) of thyroarytenoid muscles were examined and analyzed during voluntary tasks. The potential amplitude was showed by the percentage of that of the healthy lateral. The criterion of evaluation on evoked potential was attained by calculating statistical confidence interval. RESULTS: The highest evoked CMAP in group one was significantly lower than that of the others (P < 0.05), but no significant difference was observed between group two and group three (P > 0.05), so group two and group three were analyzed together. There were 2 recovered cases and 11 unrecovered cases in group one. On the basis of this criterion that a positive prognosis for laryngeal recovery was indicated when the evoked CMAP presented and there was no misdirect generated potential, correct prognostic rate was 92% (12/13). There were 11 recovered cases and 48 unrecovered cases in group two and three. The highest evoked CMAP was much higher in the recovered than in the unrecovered, significant difference was observed between them (P < 0.001). On the basis of the criterion that a positive prognosis for laryngeal recovery was indicated when the highest evoked CMAP was higher than 26. 4%, correct prognostic rate was 90% (53/59). On the basis of the criterion that a positive prognosis for laryngeal recovery was indicated when there was no misdirect generated potential and the highest evoked CMAP was higher than 26.4%, correct prognostic rate was 93% (55/59). When the interval from onset to laryngeal EMG recovering was longer than 6 months, none of these patients had return of vocal cord mobility whatever were the outcomes of laryngeal EMG. CONCLUSIONS: Correct prognostic rate can be improved if the prognosis of VCP in different courses is judged respectively by analyzing comprehensively spontaneous and evoked EMG.

Adult↗
PubMed1992

Familial incidence of hyperkalemic periodic paralysis in quarter horses.

The pedigrees of 17 horses with hyperkalemic paralysis were studied. All were first-, second-, or third-generation offspring of a common sire, 16 were registered Quarter Horses. Analysis indicated that it was unlikely that the concentration of hyperkalemic periodic paralysis in the offspring of this sire was attributable to chance. The familial nature of this condition should help veterinarians diagnostically. It also suggests that it is possible to reduce the incidence of this condition by breeding from non-affected lines of horses and reinforces the need for studies to determine whether the disease is genetic in origin. Although more affected horses were second-generation offspring, the proportion of horses affected was largest in the first generation and decreased progressively with each generation. This is probably because horses in the earlier generations have been observed for longer periods and thus clinical signs are more likely to have been noticed in these horses.

Animals↗