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Introduction: The aim of the study was to describe patterns of neuromuscular weakness using a combination of electromyography and histology, and to evaluate functional outcome in patients following complicated cardiovascular surgery., Methods: Fifteen adults requiring long-term mechanical ventilation (>15 days) following cardiovascular surgery associated with postoperative complications were prospectively included. Electrophysiological and histological analyses (muscle and nerve) were performed when failure to wean from mechanical ventilation associated with peripheral neuromuscular weakness was noticed. Functional disability was evaluated 12 months after surgery., Results: Six patients had a predominantly axonal neuropathy, six presented with myopathy, and three patients had a combination of axonal neuropathy and myopathy. All of them presented with acute tetraparesis and failure to wean from mechanical ventilation. All of the study patients who received corticosteroids exhibited a myopathic pattern (with or without axonopathic changes) but never an axonopathic pattern only. Only two of the eight survivors at 12 months were not ambulatory. These two patients had no detectable compound muscle action potential on electrophysiological examination., Conclusion: The combination of electromyographic evaluation and neuromuscular histological abnormalities could help to identify the type and severity of neuromuscular weakness, in turn helping to evaluate the patient's potential functional prognosis.

Several neurological manifestations of Lyme disease, both central and peripheral, have been described. Reported here is a case of acute transverse myelitis related to a Lyme neuroborreliosis that presented with isolated acute urinary retention and no lower-extremity impairment. This case, documented by urodynamic and electrophysiological investigations, partially resolved after 6 weeks of intravenous ceftriaxone, affording the removal of the indwelling catheter. Alpha blocker therapy was needed for 3 months, until the complete normalisation of urodynamic and electrophysiological records. This case study indicates that whenever urinary retention is encountered associated with acute transverse myelitis or alone, the patient should be investigated for Lyme disease.

Authors report a case of diabetic truncal neuropathy presenting as a painful abdominal swelling. This entity, which frequently is probably under estimated, may mimic abdominal visceral pathology and patients may be subjected unnecessary to extensive diagnosis procedures.

Propofol was assessed in laboratory animals using an experimental technique which leads to an over all appreciation of central nervous system function. After Bimar and Naquet, (1966) a battery of neurophysiological tests in the cat investigate specific primary pathways (visual evoked potentials), non specific pathways (arousal reaction) and hemodynamic response to painful aggression (stimulation of dentine). Propofol appears to be a powerful narco-hypnotic drug. More, it have an original property which is quite rapidly effective and unconnected with narcosis: a protective hemodynamic ("sympathoplegic or neuroleptic") effect. So, propofol, a new anesthetic agent, seems to be a progress with regard to other drugs used previously.

Experiments have been performed in order to study the effects of percutaneous peripheral stimulation (PCPS) both on the transmission of messages elicited by recruiting sensory units of the tooth pulp at the thalamic Centrum Medianum Level and on the jaw opening reflex (JOR). Both evoked potentials and JOR were inhibited by stimuli applied to the limbs by means of percutaneous (needle) electrodes. Observed inhibitory effects were not immediate: there was a latency period and progressive induction of these phenomena. The site of the inhibition is still unknown, nevertheless, the demonstration that PCPS was able to inhibit both evoked potentials in Centrum Medianum and JOR support the hypothesis that the analgesic effects may be due to descending inhibition blocking transmission of nociceptive information through the spinal cord.

The effects of weak intensity percutaneous peripheral stimulations (SPPc) on the transmission of nociceptive messages induced by stimulation of the dental pulp have been studied on anaesthetized cats. 1. The jaw opening reflex (ROG) and the evoked potentials in the thalamic center median (CM), by stimulation of the dental pulp, disappear after a mean of 30 min after the start of SPPc. 2. These effects are analogous to those obtained by stimulation of the periaqueductal gray matter (St.GC) or by I.V. morphine injection. 3. The I.V. injection of the morphine antagonist (Nalorphine) blocks both the effects of the SPPc and those of the St.GC. 4. The authors put forth the hypothesis of a common mechanism of action of the SPPc and the St.GC which, through the liberation of endogenous morphinomimetic substances, would activate descending inhibitor impulses.

The blockade of effects induced by percutaneous peripheral stimulation were abolished by injection of an opiate antagonist as nalorphine. Our results lead to the hypothesis that central and peripheral stimulations act by the same mechanism in producing blockade of noxious impulses. One may suggest that peripheral stimulations induce release of endogenous morphine-like substances which in turn give descending inhibition.

As the clinical manifestations of spasmophilia are characterized by their striking polymorphism, quantitative assessment, which is requisite in order to evaluate therapeutic effectiveness, is a difficult task. The authors have attempted to analyze clinical, electrical and biological data from 30 patients. Each of these patients, given only manganese-cobalt oligosol and magnesium oligosol for two months, in two daily doses, had at least two groups of symptoms. Analysis of results shows that the most significant improvement was clinical: improvement was satisfactory or very satisfactory in 83% of patients tested, with muscular relaxation being recorded first, In relation with these clinical results, is the 59% improvement rate in EMG controls. Improvement in overall laboratory data was conclusive in only 24% of patients; however, if only the changes in intraerythrocytic magnesium, which is the only parameter with real clinical value (60% of abnormal results before treatment) are considered, improvement or return to normal values was recorded in 83% of cases.

Unlabelled: The author's describe: I. METHODS OF ANALGESIC CUTANEOUS STIMULATION: I) Transcutaneous analgesic stimulation: Stimulations realized by biphasic asymetrical "waves" of 0 to 80 milliamps intensity for a frequency of 10 to 100 cycles/S. -Place of the stimulation: a painful area. -Stimulation length: 15 to 20 minutes, repeated during several days., Results: appreciate patients tolerance to the tingling sensation. Test the analgesic effect, sometimes sufficient to treat the patient. 2) Analgesic percutaneous stimulation: The percutaneous electrode is applicated to the dura, without penetrating it. Same types of results as for transcuteneous stimulation but more precise. II. DEFINITION of the indication of chronic implantation of an analgesic stimulator. Studying results of repeated analgesic transcutaneous stimulations allows to distinguish between several possibilities. I) Intolerance of the sensation of stimulation: Contra-Indication or increasing of the pain. 2) Complete and lasting amelioration leads to: Chronic transcutaneous neurostimulation. 3) Partial amelioration, No amelioration leads to: Acute percutaneous stimulation either successful results after stimulation, : Chronic implantation: -of peripheral nerve -on a peripheric nerve -of dorsal column -on dorsal column, either paraesthesis without Analgesia:? III - EXPERIMENTAL APPROACH TO THE MECHANISM OF ACTION OF THE "ANALGESIANT" ELECTRIC STIMULATION. A cutaneous "analgesiant" stimulation produces, in the cat, the inhibition of evocated potential in C.M. by "nociceptive" stimulation of the sciatic nerve. The inhibition only appears after a 30 minutes latence. This let suppose different mechanisms from the "Gate Control" theory. The authors specify their personal results (Tab. 2.)

1. The electrical activity of external anal sphincter (EAS) and internal anal sphincter (IAS), and the endo-anal pressure were recorded during the miction on 10 male adults with no signs of anorectal nor urologic affection. 2. During the premictionary period, the sympathetic hypertonicity was due to a large vesical proprioceptive activity; that initiated a higher frequency and amplitude of the IAS slow potential oscillations, and masked the inhibitory parasympathetic effect usually triggered by rectal distension. 3. During the vesical systolic phase the vesico-anal reflex induced by a parasympathetic activation and by: (a) a total absence of the EAS electrical activity during the duration of the miction period; (b) a two stage development of the IAS electrical activity: a tonic first stage of short duration and constant activity, followed by a second larger stage of variable form in accordance with the type of pattern (tonic, intermediary of which followed a similar developmental stage to that of the IAS. 4. This vesico-anal reflex makes it possible to assume that IAS activity plays a specific and important functional role in the maintenance of anal continence.

The authors analyse and compare the clinical and urodynamic results of 16 tubed caecocystoplasties and 5 detubed ileocaecocystoplasties. The urodynamic assessments were performed between 2 months and up to 4 years after the operation. After a period of about 6 months, there was a functional difference between these two types of reservoir. The loss of pressure peaks in detubed reservoirs is not sufficient to ensure complete nocturnal continence. Neovesico-sphincteric synergy is responsible for real sphincteric self-re-education. Rationally, a detubing procedure in bladder replacement is only desirable in the case of a "deficient" sphincter.

In a systematic study we attempted to activate the respiratory neurons antidromically by stimulating the spinal cord and the vagus. This has led to an anatomical and functional classification of the neurons: bulb-spinal neurons whose axons enter the spinal cord, vagal motoneurons, propriobulbar neurons which cannot be activated antidromically. We used simultaneously other tests (localization, response to Hering-Breuer reflexes or to cortical stimulation) which gave positive results. Two groups of respiratory neurons were apparent: a dorsal respiratory nucleus with only inspiratory bulbo-spinal neurons and a ventral respiratory nucleus with inspiratory and expiratory bulbo-spinal neurons, vagal motoneurons and propriobulbar neurons. The bulbo-spinal neurons and some propriobulbar neurons are normally related to Hering-Breuer reflexes evoked by lung inflation or deflation, but the recurrent laryngeal motoneurons or fibres and some propriobulbar neurons can give a paradoxical response to lung inflation. By cortical stimulation the propriobulbar neurons show only an arrest of their discharge, whereas the bulbo-spinal neurons give a burst of spikes followed by an inhibition. These results led to the following conclusions: (i) the propriobulbar neurons do exist; (ii) some neurons classified as medullary respiratory neurons have not really a ventilatory function: they belong to the laryngeal system; (iii) it is fundamental to use systematically the antidromic test and some other ones to know exactly the hodological situation of the neurons in the respiratory complex.