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In 30% of patients with epilepsy seizure control cannot be achieved with medications. When medical therapy is not effective, and epilepsy surgery cannot be performed, vagus nerve stimulator (VNS) implantation is a therapeutic option. Laryngeal patterns in vagus nerve stimulation have not been extensively studied yet. The objective was to evaluate laryngeal patterns in a cohort of patients affected by drug-resistant epilepsy after implantation and activation of a vagus nerve stimulation therapy device. 14 consecutive patients underwent a systematic otolaryngologic examination between 6 months and 5 years after implantation and activation of a vagus nerve stimulation therapy device. All patients underwent fiberoptic endoscopic evaluation, which was recorded on a portable device allowing a convenient slow-motion analysis of laryngeal patterns. All recordings were blindly evaluated by two of the authors. We observed three different laryngeal patterns. Four patients showed left vocal cord palsy at the baseline and during vagus nerve stimulation; seven showed left vocal cord palsy at the baseline and left vocal cord adduction during vagus nerve stimulation; and three patients showed a symmetric pattern at the baseline and constant left vocal cord adduction during vagus nerve stimulation. These laryngeal findings are here described for the first time in the literature and can be only partially explained by existing knowledge of laryngeal muscles and vagus nerve physiology. This might represent a new starting point for studies concerning laryngeal physiology and phonation, while the vagus nerve stimulation therapy could act as a new and ethical experimental model for human laryngeal physiology.

The aim of this study was to compare the safety, tolerance, and diagnostic efficacy of iomeprol 350 mg I ml-1, iohexol 350 mg I ml-1, and iopamidol 370 mg I ml-1 in 90 adult patients undergoing intravenous urography. Radiographs obtained 5, 10 and 15 min after contrast injection were blindly graded for quality on a four point scale as: 0, non-diagnostic; 1, diagnostic but of limited quality; 2, diagnostic and of good quality; 3, fully diagnostic and of very good quality. The sum of these scores indicated the overall diagnostic quality (0-4, non-diagnostic; 4-8, diagnostic; 9-12, good or excellent). Contrast tolerability was evaluated by discomfort (heat or pain) associated with injection of the test compounds, and patients were monitored and questioned for adverse experiences. The quality of the individual radiographs was assessed as diagnostic and good or fully diagnostic and very good in most cases, with no significant differences between the three study groups, and overall scores were predominantly good or excellent (p = 0.55). All adverse reactions were transient and non-serious, and most of them were reported as mild in intensity. There were no significant differences between the three groups for heat sensation (p = 0.29). Pain at the injection site was reported only in the iohexol group (p = 0.104). It is concluded that iomeprol 350 mg I ml-1 is at least as safe and effective as iohexol 350 mg I ml-1 or iopamidol 370 mg I ml-1 when used for intravenous urography.

The aim of this double-blind, parallel group study was to compare the safety, tolerance and diagnostic efficacy of iomeprol 350 mgI/ml and iopromide 370 mgI/ml in 100 adult patients undergoing intravenous excretory urography. Fifty patients were randomised to receive 50 ml iomeprol 350 mgI/ml and 50 to receive 50 ml iopromide 370 mgI/ml. Intravenous administration of the contrast agents was always completed in 30 seconds. Images were obtained immediately after and 5, 10 and 15 min after completion of contrast medium injection. Nephrogram and pyelogram opacification quality was blindly graded according to a four point scale as follows: 0, nondiagnostic; 1, diagnostic but of limited quality; 2, diagnostic and of good quality; 3, fully diagnostic and of very good quality'. At the end of each individual patient study, the overall diagnostic quality of the procedure was reported as the sum of the scores attributed to each quality of nephrogram and pyelogram opacification quality on different images (0-4, nondiagnostic procedure; 4-8, diagnostic procedure; 9-12, excellent or good procedure). The tolerability of the test compounds was evaluated in terms of discomfort (heat and pain) associated with the injection of the test compounds. All patients were continuously monitored for adverse experiences for 1 h after completion of the urographic procedure. Reporting of untoward reactions was both spontaneous and elicited. The quality of the radiographs was judged as excellent or good in most cases, without significant differences between the two study groups. The distribution of scores of overall diagnostic quality of procedures was similar for the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

A battery of auditory brain stem response (ABR) tests has been used to evaluate 39 multiple sclerosis (MS) subjects (9 with probable, 8 with possible, 6 with suspected and 16 with definite MS, according to conventional classification of the disease). Test battery included evaluation of ABR waveform, latencies and interpeak intervals, test-retest variability, rate-induced ABR changes, binaural increase of wave-V amplitude and effect of ipsilateral masking with broad-band noise. Test results allowed a measure of the sensitivity, specificity and efficiency of each test in the battery. The high efficiency values thus obtained validated each test in the battery when normals were compared with definite MS patients. No single test, however, proved to be sufficient--by itself--to reliably distinguish subjects with earlier stages of the disease, suggesting that a combined evaluation of tests is necessary to fit better the clinical classification. When compared with 'conventional' ABR analysis, 'sensitized' ABR tests--i.e. the measures of test-retest variability, binaural increase of wave-V amplitude and the effect of ipsilateral broad-band noise masking--showed higher percentages of positive results in subjects with no clinical signs of brainstem and midbrain involvement. Sensitized tests therefore appeared more suitable to reveal a brainstem subclinical involvement.