Cardiac extension of intravenous leiomyomatosis with successful resection

The density and fine structure of the peripheral nerve system in various skin lesions of 64 patients with atopic dermatitis (AD) was quantitatively analyzed by immunohistochemical staining with antibodies directed against protein gene product (PGP) and substance P (SP). The density of PGP-positive peripheral nerves was 2.5 x 10(3) microns2/delta s (delta s = 0.24 mm2 selected area) in early acute lesions, 3.8 x 10(3) microns2/delta s in subacute lesions, 4.9 x 10(3) microns2/delta s in lichenified lesions and 7.1 x 10(3) microns2/delta s in prurigo lesions of AD. The density of nerve fibers in subacute, lichenified and prurigo lesions was significantly higher than in uninvolved skin of AD patients (2.0 x 10(3) microns2/delta s). Electron microscopically, bulging of axons with many mitochondria and a loss of their surrounding sheath of Schwann cells suggests that the free nerve endings in skin lesions of AD are in an active state of excitation. Many pinocytotic vesicles in the periphery of basal keratinocytes facing nerve endings which contained many neurovesicles suggests reciprocal effects between keratinocytes and nerve endings. The number of SP-positive nerve fibers in AD lesions was far less than one-tenth of the number of PGP-positive nerve fibers.     

Arch form in American blacks and whites with malocclusions

Single nerve lesion or mononeuropathy caused by extrinsic compression of hematoma or hemarthrosis is consistently reported for hemophilic patients. To study the manifestation of peripheral nerve lesions, an extensive nerve conduction study of peripheral nerves and specific nerves in correlation with clinical involvement was carried out on 126 hemophilic patients. We found 24 patients with 34 peripheral nerve lesions. The frequency of nerve lesion positively correlated with the severity of hemophilia (p < 0.01) and increasing age (p < 0.05). Nerve lesions occurred more commonly in lower extremities than in upper extremities. The femoral nerve was most commonly involved. Seven patients were identified to have mononeuropathy multiplex with 2 or more nerve lesions involving more than one extremity. All of these patients had chronic condition. Our findings suggest that mononeuropathy multiplex may occur in hemophilic patients.     

The role of nasal chemical senses in garter snake response to airborne odor cues from prey.

Garter snakes increase tongue-flick rates in the presence of airborne odorants (amyl acetate, limonene, earthworm wash vapor, fish water vapor, earthworms, goldfish) but not water vapor. Main olfactory (MO) nerve lesions result in loss of this tongue-flick rate elevation in the presence of airbome odorants. Vomeronasal (VN) nerve lesions result in a diminution of tongue-flick rate elevation. Garter snakes discriminate between the 2 arms of a maze containing airbome earthworm odor as compared with a blank control. Following MO nerve lesions, snakes fail to make this discrimination. Following VN nerve lesions or VN duct suture, snakes are initially able to make the discrimination but may eventually cease to prefer the prey-odor side of the maze and may stop eating prey rewards. These results support the idea that airbome odorants are detected by the main MO system and that such detection does not require a functional VN system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Proximal median and ulnar resections. Results of primary and secondary repairs

PURPOSE OF THE STUDY: Recovery after median and ulnar nerve proximal repair is widely appreciated. The place and time for secondary functional reconstruction remains controversial. MATERIAL AND METHOD: From January 1983 to January 1990, 66 patients suffering from proximal injury of the median or ulnar nerves underwent nerve repair. Forty-five patients had a postoperative follow-up of more than 24 months: 24 isolated ulnar nerve lesions, 12 isolated median nerve lesions, and 9 combined median and ulnar nerve lesions. Ten patients were given a primary microsurgical nerve suture in our department. Thirty-eight patients underwent a delayed or secondary nerve repair of one or both nerves: 8 secondary nerve sutures, and 35 nerve grafts in 31 patients. RESULTS: Muscular strength, sensitivity, motion, and pain were better after primary nerve sutures (when technically possible) or after shortly delayed secondary sutures, although 40 per cent of patients treated with nerve grafts get final "good" or "very good" results. The time between the injury and nerve repair was the most significant prognosis factor. Results of ulnar nerve repairs at the elbow were statistically better with anterior transposition as compared to in situ repairs (p < 0.005). Fourteen patients required secondary functional reconstruction. Tendon transfers were performed at least 24 months after nerve repair. DISCUSSION: Nerve repair of proximal lesion to the median or ulnar nerves depends on the type of injury, but is advised even when delayed. Residual deficit following nerve repair should require functional transfers depending on hand sensitivity and extrinsic function.     

Isolated cranial nerve palsies in multiple sclerosis

During a 10 year period 24 patients with definite multiple sclerosis with isolated cranial nerve palsies were studied (third and fourth nerve: one patient each, sixth nerve: 12 patients, seventh nerve: three patients, eighth nerve: seven patients), in whom cranial nerve palsies were the presenting sign in 14 and the only clinical sign of an exacerbation in 10 patients. MRI was carried out in 20 patients and substantiated corresponding brainstem lesions in seven patients (third nerve: one patient, sixth nerve: four patients, eighth nerve: two patients). Additional abnormal findings of electro-oculography, or masseter reflex, or blink reflex, or combinations of these were found in 20 patients and interpreted in favour of a brainstem lesion at the level of the respective cranial nerve. In 11 of 14 patients with isolated cranial nerve palsies as the presenting sign of multiple sclerosis, dissemination in space was documented by MRI, and in the remaining three by evoked potentials. In patients with multiple sclerosis with isolated cranial nerve palsies, MRI is the most sensitive method of documenting dissemination in space and electrophysiological testing the most sensitive at disclosing brainstem lesions.     

Cutaneous silent period in masseter muscles: a clinical and electrodiagnostic evaluation

In 35 normal subjects electromyographic silent periods were constantly evoked bilaterally in the masseter muscles during maximal contraction after unilateral electrical stimulation over the infraorbital or mental nerve. Findings in this study and data obtained in 30 patients suffering from trigeminal (26) and facial (four) nerve lesions suggest that the silent period evoked according to our methods is cutaneous in origin. The trigeminal sensory root forms the afferent limb of the silent period reflex. Its central pathway is thought to pass both crossed and uncrossed through the pons. Determination of the cutaneous silent period might be of value for the demonstration of trigeminal nerve lesions and to supplement results concerning other brain-stem reflexes.     

Chemical senses involved in garter snake prey training.

Trained 8 garter snakes to follow earthworm-extract trails in a multiple-choice maze and then subjected them to either sham surgery or complete bilateral vomeronasal nerve transection. Ss with sham surgery trailed and ate at preoperative levels; Ss lacking a functional vomeronasal system developed a feeding deficit and trailed at chance levels. In Exp II 16 Ss were preoperatively tested for ability to follow a battery of trails including a range of trail concentrations and 2 trail manipulations. After baseline testing, 2 Ss were subjected to sham surgery, 7 to olfactory nerve transection, and 7 to vomeronasal nerve transection. Ss with vomeronasal nerve lesions demonstrated trailing and feeding deficits commensurate with the extent of nerve damage. Ss with olfactory nerve cut and sham surgery followed all trails at preoperative levels and maintained high tongue-flick rates when following stronger extract trails. Four Ss (2 with sham lesions, 1 with olfactory nerve lesion, and 1 with a partial vomeronasal nerve lesion) were tested with the vomeronasal ducts sutured closed. These Ss were unable to follow any trails at better than chance levels, but most continued to attack and ingest earthworm bits. Results suggest that garter snakes are heavily dependent on the vomeronasal system for following chemical prey trails. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sixty percent lidocaine tape alleviates pain on injection of propofol after diminishing venipuncture pain

Cytological changes of feather pulp lesions (FPL) sampled chronologically from the same specific-pathogen free chickens inoculated with Marek's disease virus serotype 1 (MDV) were examined, comparing with their histological changes. The birds having Marek's disease (MD) lymphomas or nerve lesions exhibited the characteristic lesion changes on the cytological smears of FPL; the initial non-suppurative inflammatory to the late lymphomatous FPL. The birds having neither the MD visceral lymphomas nor the nerve lesions manifested only non-suppurative inflammatory FPL on the cytological smears throughout the experimental periods. Histological evaluation of FPL sampled from the same birds confirmed as above mentioned cytological results. From these results, the cytological evaluation of FPL proved to be an effective diagnostic and prognostic tool in foreseeing MD incidence.     

Differential diagnosis in facial nerve palsy: a clinical review

BACKGROUND: The facial nerve possesses five functional components and manifests a complex course from its origin in the motor cortex to its peripheral distribution. Pathologies that impact the facial nerve in various locations along its route result in characteristic clinical manifestations that often involve other neurologic entities. CASE REPORTS: Case reports of three patients who manifested lesions of the facial nerve are presented. Each case represents a specific facial nerve pathology occurring within the supranuclear, nuclear, and infranuclear location. An anatomic, regional, and etiologic approach to the spectrum of facial nerve disorders is provided. Additionally, hyperkinetic facial disorders is discussed, and the management of facial nerve palsy is emphasized. CONCLUSION: The clinician must understand the fundamental anatomy and distribution of the facial nerve in order to localize lesions and institute the appropriate management. Abnormalities of lid position and insufficient corneal wetting are problematic. All efforts should be directed toward the maintenance of corneal integrity by appropriate wetting strategies.     

Facial nerve enhancement on gadolinium-DTPA in a case with neurosarcoidosis

In a case of neurosarcoidosis with bilateral facial nerve palsy and hydrocephalus, contrast-enhanced magnetic resonance imaging (MRI) study and angiotensin converting enzyme (ACE) activities in cerebrospinal fluid (CSF) were valuable for the diagnosis and the follow up. Facial nerve lesions were demonstrated on gadolinium-DTPA enhanced MRI. The disappearance of enhancement was concomitant with the amelioration of facial nerve palsy after corticosteroid therapy.     

A new major projection from locus coeruleus: the main source of noradrenergic nerve terminals in the ventral and dorsal columns of the spinal cord

Almost all catecholamine (CA)-containing nerve terminals in the ventral column, intermediate grey and ventral half of the dorsal column disappeared after bilateral stereotaxic lesions of nucleus locus coeruleus, as revealed by fluorescence histochemistry. Some of the CA nerve terminals in the dorsal half of the column seemed to be unaffected by the lesions, as well as the CA terminals innervating the thoracic sympathetic lateral column and the band of nerve terminals crossing the midline and innervating the central grey. This coeruleo-spinal pathway in the rat is located in the anterior funiculus and the ventral parts of the lateral funiculus. A schematic map of the different CA projections to the spinal cord is presented. It was concluded that locus coeruleus innervates almost all parts of the central nervous system.     

Borderline--tuberculoid leprosy: clinical and immunological heterogeneity

The authors analysed some immunological criteria in leprosy patients diagnosed as borderline tuberculoid by the presentation of different grades of skin lesions as well as different grades of nerve involvement. Only 50% of the patients presented a single skin lesion and 58% had none or only one affected nerve. Nineteen patients (39.6%) showed a positive lepromin reaction (induration > or = 5 mm). Patients with a positive skin test had a greater number of skin lesions when compared with patients with a negative lepromin test. Fifty-seven percent of the patients were found to be positive using a lymphoproliferation test (LTT) in response to Mycobacterium leprae antigens. Positive LTT results did not correlate with the number of skin lesions, but patients unresponsive to LTT had a lesser extent of nerve involvement. Four out of 18 patients (22%) released high IFN gamma levels in PBMC culture stimulated by M. leprae. (mean U/ml +/- SD = 142 +/- 72). All of these 4 patients presented only one skin lesion, although three of them had more than one affected nerve. Nineteen out of 21 patients (90.5%) showed no anti-PGL-1 antibodies in their serum. The low levels of anti-PGL-1 antibodies among these patients confirmed their tuberculoid background even in those with multiple skin lesions. These findings seem to attribute an important role to IFN gamma in restraining the spreading of the infection in the skin, but IFN gamma may have an opposite effect on the nerves. The potential pathological effects of IFN gamma during the delayed type of hypersensitivity can be related to its ability to synergise with other inflammatory cytokines such as TNF alpha, IL-1 beta, and others.     

Stimulation of IL-2 production and CD2R expression by splenopentin analogs

A multiplicity of peripheral nerve syndromes may develop in patients with diabetes mellitus, the commonest of which is a chronic symmetric sensory polyneuropathy, often associated with autonomic neuropathy. Once established, it is largely irreversible. Acute painful diabetic sensory neuropathy is a separate entity with a favorable prognosis. It now seems likely that chronic inflammatory demyelinating polyneuropathy occurs with greater frequency in diabetic subjects than in the general population and is one explanation for the occurrence of a predominantly motor polyneuropathy. Focal and multifocal peripheral nerve lesions are seen mainly in older diabetic patients and comprise cranial, thoracoabdominal and limb nerve lesions, the last including proximal lower limb diabetic motor neuropathy (diabetic amyotrophy). With this wide array of disorders and the frequency of diabetes, it is important to distinguish those that are directly or indirectly related to diabetes from those that have a coincidental relationship.     

Magnetic nerve root stimulation in two types of brachial plexus injury: segmental demyelination and axonal degeneration

Magnetic cervical nerve root stimulation was performed in 9 patients with plexopathies secondary to suspension (SP) and in 12 cases with neurogenic thoracic outlet syndrome (NTOS). The findings were compared with those of the previously reported case groups: n-hexane polyneuropathy (HPNP), inflammatory demyelinating polyneuropathy (IDP), and motor neuron disease (MND). Muscle responses elicited by magnetic stimulation had very high rates of amplitude and area loss in the neck-axilla segments of the 6 SP patients. This, along with the other electrophysiological findings, suggested the presence of segmentally demyelinating plexus lesions. In NTOS patients, magnetic stimulation findings were not significantly different from those of the controls. Neck-axilla segment amplitude and are reduction rates in SP and IDP patients were significantly higher than those found in NTOS, HPNP, and MND groups, implying that magnetic nerve root stimulation may have a role in the demonstration of segmentally demyelinating lesions involving proximal nerve segments.     

Laboratory observations of aggregative behavior of garter snakes, Thamnophis sirtalis: Roles of the visual, olfactory, and vomeronasal senses.

Two experiments determined (a) whether male garter snakes require a functional vomeronasal or olfactory system to return to previously preferred shelter locations and (b) the sensory modalities used to aggregate in the absence of previously deposited chemical cues. In Exp I, 22 male garter snakes with vomeronasal nerve lesions did not return to previously preferred shelter locations when tested individually. However, when tested with a group that included 9 control Ss, they returned to previously preferred shelters. The shelter-selection behavior of Ss with olfactory nerve lesions improved postoperatively, whereas the behavior of Ss with sham lesions was unchanged. In Exp II, 32 Ss were tested for aggregation in aquaria in which the substrate and other contents were cleaned between trials. After blindfolding or olfactory nerve cuts, Ss aggregated at normal levels. When Ss' vomeronasal ducts were sutured closed, aggregation scores were significantly depressed, although 2 of the 3 groups with vomeronasal duct sutures did aggregate just above change levels. Results from both studies indicate that use of chemical signals by garter snakes in shelter selection and aggregation is mediated by the vomeronasal system and that neither the olfactory nor the visual system is critical for these behaviors. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurotrophic factors and their receptor expressions in human neuropathies

Currently, many neurotrophic factors are known to promote peripheral nerve regeneration after nerve injury or nerve degeneration. Among such neurotrophic factors, neurotrophin family (NGF, BDNF, NT-3, NT-4) and GDNF are most potent ones, and they have been demonstrated to express in the distal stump of the experimental nerve transection. In this study, we assessed the expression levels of neurotrophin mRNAs and GDNF mRNAs and their receptor mRNAs for p75, TrkA, TrkB, TrkC, GDNFR alpha and Ret in the sural nerve biopsy specimens from various human neuropathies. All the neurotrophin mRNAs and GDNF mRNAs were significantly elevated in the diseased nerves and their expression levels well correlated to the extent of T-cell and macrophage invasion. p75 and GDNFR alpha mRNAs were upregulated in correlation to the extent of axonal degeneration. On the other hand, the TrkB and TrkC mRNAs were likely downregulated. These findings suggest that the regulatory mechanism for expression of neurotrophins and GDNF mRNAs and their receptor mRNAs are different. Significant upreguration of the neurotrophic factor mRNAs in the nerve lesion would be the compensation mechanism reacting for the lesion, even in the lesions which are progressing in severity. Extrinsic supplement of these neurotrophins would be beneficial for promotion of repair of the peripheral nerve lesion particularly when they are progressive lesions.     

CT myelography for diagnosis of brachial plexus avulsion in small animals

Avulsion of nerve roots of the brachial plexus can be diagnosed clinically, neurologically, radiographically and by electromyography. But like the myelography these techniques are inprecise for determination of the severity (partial or complete disruption) and the localization of the lesion. In human medicine the combination of computerized tomography with myelography shows high accuracy. Veterinary reports of experience in this field are not yet known. The aim of the present study was to demonstrate nerve root avulsions using myelography and computerized tomography. Three dogs and one cat with traumatic lesions of the brachial plexus were examined. The lesion could be seen in all patients. Thus CT-myelography results in an improved prognostic assessment of brachial plexus paralysis. Moreover, this technique could become one of the most important diagnostic methods for brachial plexus lesions involving nerve root reinsertion--neurotizations in veterinary medicine.     

Influence of centrifugal pathways on forward masking of ventral cochlear nucleus neurons

When responses to one part of a sequence of auditory signals reduce the responses to a subsequent portion of the signal, "forward masking" results. Although forward masking occurs in the auditory nerve, that observed in the ventral cochlear nucleus (VCN) more closely resembles psychophysical forward masking. In contrast to the auditory nerve in which the amount of forward masking is proportional to the amount of excitation produced by the masker, most VCN neurons show a poor correlation between forward masking and excitation produced by the masker, indicating a more complex interaction between responses to adjacent signals. This study tested the hypothesis that one component of forward masking is produced by inputs from centrifugal neural connections to the VCN. The centrifugal pathways were interrupted with knife-cut lesions medial to the CN. Responses of single units obtained 60 minutes after the lesions were compared to those obtained before the lesions. In primarylike, sustained chopper and on units the lesions resulted in a reduction in forward masking and enhanced recovery. In contrast, lesions resulted in increased masking in primarylike-notch and low-intensity chopper units. The relationship between masker-elicited excitation and forward masking became more monotonic for transient choppers and on units, approaching that observed for auditory nerve fibers. These effects are probably the result of removal of both inhibitory and excitatory inputs, ultimately reflecting a balance of excitation and inhibition to each neural population in the VCN.     

Facial nerve neuromas presenting as acoustic tumors

Facial nerve tumors can present as masses in the internal auditory canal or cerebellopontine angle and may mimic an acoustic neuroma. These tumors can occur in any segment of the nerve from the brain stem to the neuromuscular junction. Prior to the advent of computed tomography and magnetic resonance imaging with gadolinium, facial nerve tumors were often difficult to diagnose. Even with these modalities it may be difficult to distinguish preoperatively between an acoustic neuroma and a facial schwannoma. Particular signs and symptoms associated with facial nerve tumors (in the spasms, and a facial tic. These symptoms, combined with modem radiologic studies, should allow for more accurate diagnosis, patient counseling, and treatment. This report presents a series of 32 facial nerve tumors diagnosed and treated at The Otology Group from 1975 to 1992. Of these lesions, 12 (38%) were thought to be acoustic neuromas. Eighteen tumors were correctly identified preoperatively as facial nerve tumors. Two facial nerve tumors were found incidentally.     

Histologic analysis of the lumbosacral nerve roots after compression in young and aged rabbits

STUDY DESIGN: The histologic changes in the lumbosacral nerve roots of aged rabbits because of chronic (graded) and acute compression were compared with those seen in young rabbits. OBJECTIVES: To study differences in the process of recovery from nerve compression between the aged and the young. SUMMARY OF BACKGROUND DATA: Clinical findings often differ between nerve compressive lesions in young and aged patients. Little has been reported on the pathologic basis of this difference. METHODS: Forty-five Japanese white rabbits were used. The cauda equina and spinal nerve root were compressed with a device specifically designed for this purpose. Nerve compression was applied to the dura mater and nerve roots after partial laminectomy. The specimens were sampled at 1 month or 3 months after acute or graded nerve compression. RESULTS: An increase in small myelinated fibers, consistent with the process of regeneration, was observed by light microscopy; this difference was greater in the young group than in the aged group. Reactive degenerative changes, as seen by electron microscopy, were more often observed in the aged group than in the young group. CONCLUSIONS: These findings demonstrate the suppression of regeneration and the latent fragility of the aged neural tissue. This may explain the clinical findings observed in aged patients with degenerative lumbar lesions.