Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study.

Background: Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests.

Methods: We studied a group of 57 patients submitted to rectal resection for adenocarcinoma.

Persistence of high-dose oxaliplatin-induced neuropathy at long-term follow-up.

Oxaliplatin (L-OHP) has become a standard treatment for advanced colorectal cancer and a valid option for patients in the adjuvant setting. Compared with cisplatin, L-OHP has no renal toxicity, only mild hematological and gastrointestinal toxicity, while neurotoxicity is the limiting toxicity. This side effect has been described as a transient distal dysesthesia, enhanced by exposure to cold, and as a dose-related cumulative mild sensitive neuropathy.

Simultaneous occurrence of linear scleroderma and homolateral segmental vitiligo.

Localized scleroderma and vitiligo only rarely have been reported to occur simultaneously. Here we report a case of a 21 year old man affected with both linear scleroderma of the left upper limb and homolateral segmental vitiligo of the trunk. Since the two diseases appeared during the same period, involved the same side of the body and their progression paralleled, a possible non-coincidental association between these two diseases is discussed.

Demyelinating disease in monoclonal gammopathy of undetermined significance.

We describe herein the case of a 57 year old man who, over the last five years, has presented ataxic and spastic gait on the right side, a reduction in fine motor movement of the fingers mainly on the right side, superficial right side brachiocrural hypoesthesia and a marked dysarthria associated with internuclear ophthalmoplegia. The neurological picture, after an initial progressive worsening which lasted some months, remained relatively stable over the years. Repeated magnetic resonance imaging (MRI) of the brain and spinal cord documented the presence of demyelinating plaques spread in the white matter of the periventricular region and the semioval centres, and a right side paramedian plaque at the C4-C5 level, none of which were in the active phase.

Brachial plexus neuropathy as unusual onset of diffuse neurolymphomatosis.

We present a patient with a large B cell gastric lymphoma in total remission who, after 4 months, developed a fatal progressive peripheral neuropathy with an unusual early involvement of the right brachial plexus. No evidence of lymphoma was found at whole body computed tomography, magnetic resonance imaging of the head, cervical spine and right brachial plexus, bone marrow biopsy or repeated lumbar punctures. The diagnosis of neurolymphomatosis was made only at postmortem examination.

Nerve-sparing surgery in rectal cancer: feasibility and functional results.

Traditional rectal cancer surgery has been burdened with a high rate of sexual and urinary dysfunctions due to intraoperative injury or the cutting of the sympathetic and/or parasympathetic nerves. The experience acquired in the last ten years with total mesorectal excisions has permitted the use of the "nerve-sparing" technique. The present study regards 239 patients from two surgical centres, most of whom underwent sphincter-saving radical surgery between 1994 and 1998 with the above mentioned technique for resectable colon cancer.

Epilepsy and gliomas: incidence and treatment in 119 patients.

One hundred and nineteen consecutive patients affected by supratentorial gliomas were studied in order to determine the incidence of seizure at diagnosis, the occurrence of subsequent seizures and the efficacy of anticonvulsant treatment. The overall incidence of seizures as presentation symptom was 52% (62 patients). Preoperative seizures were present in 83% of patients affected by low-grade astrocytoma, in 46% of patients affected by anaplastic astrocytoma and in 36% of patients affected by glioblastoma.

Neurophysiological evaluation of sexual dysfunction in patients operated for colorectal cancer.

Sexual dysfunction after colorectal cancer surgery may be severe and occurs in 25% to 100% of cases. Thirty-eight patients underwent colorectal resection; eight (21%) who were totally impotent and two (5%) who had ejaculatory failure were therefore studied to better understand the neurophysiological alterations related to this type of surgery. The patients were evaluated after surgery with electrophysiological testing, including examination of the sacral reflex (SR), pudendal somatosensory evoked potential (PEP), and motor evoked potential (MEP) responses.

Paclitaxel neurotoxicity: clinical and neurophysiological study of 23 patients.

Paclitaxel is the prototype of a new class of chemotherapeutic agents with an antimitotic effect that is related to its ability to interfere with the microtubule system. It causes peripheral neurological toxicity by means of its activity on the axonal microtubules. To define the clinical and neurophysiological characteristics of paclitaxel neuropathy 23 patients undergoing paclitaxel therapy at a dose of 175 mg/m2 were studied.

Vinorelbine neurotoxicity: clinical and neurophysiological findings in 23 patients.

Vinorelbine (5'-noranhydrovinblastine) is a new semisynthetic antineoplastic vinca alkaloid which interfers with axonal transport, inducing spiralisation of axonal microtubules and resulting in peripheral neurotoxicity. A prospective detailed neurological and electrophysiological evaluation was performed in 23 patients treated with 25 mg vinorelbine a week. All patients developed a sensory-motor distal symmetric axonal neuropathy.

Neurophysiological examination of end-plate function in patients with lung cancer.

Twenty-eight patients affected by lung cancer were studied with neurophysiological and clinical examinations to show the prevalence of alteration of neuromuscular transmission. During repetitive stimulation at 20 Hz we found in 6 cases (22%) an increment (> 20%) and in 4 cases a decrement ( > 10%) of the size of muscle action potentials. In 15 patients (57%) we found low sensory action potential amplitude (< 11 uv).

Neurotoxicity of antitumoral IL-2 therapy: evoked cognitive potentials and brain mapping.

Antitumoral interleukin-2 (IL-2) therapy is frequently associated with a neurotoxicity that manifests itself in neuropsychiatric disturbances and, more rarely, with neurological focal signs. With the aim of documenting the involvement of cognitive functions after IL-2 treatment, we studied 20 patients using evoked cognitive potentials (P300) and computer analysis of the EEG signal. A comparison of the tests performed before and after the subcutaneous infusion of IL-2 showed a significant lengthening in mean P300 latencies and a percentage increase in the EEG frequencies contained with the delta and theta bands, especially in the frontal regions.

Brain-stem auditory evoked potentials in supratentorial brain tumors.

A group of 42 adult patients with supratentorial brain tumors were studied with computed tomography (CT or/and NMR) and brain-stem evoked potentials (BAEPs). 12 patients had meningiomas and 30 had malignant tumors (gliomas and metastases). The latencies of wave V and of the interpeak latency I-III, III-V and I-V were evaluated both on the lesion side and the opposite side.

The VEP in evaluation of pituitary tumors.

12 patients with pituitary tumors were studied with VEP, to demonstrate involvement of the optic chiasma. In 3 patients VEP was recorded pre- and post-surgery to evaluate a modification in the shape and latencies of the potentials. 2 patients were studied only pre-surgery, the other 7 post-surgery.

The effect of brain radiotherapy on the P3 component of ERP's.

Nine patients with lung cancer without brain metastasis were studied pre and post brain prophylactic radiotherapy (30 Gy) to verify the effect of radiation on the cognitive processes. The P3 component of event-related potentials was used in this study. The latencies pre and post-radiation were compared and a significant delay (p less than 0.

Silent period in spinal cord pathology.

The silent period evoked by the electrical stimulus of the abductor pollicis brevis and the triceps surae muscles was studied in both normal subjects and in patients affected by spinal compression, by multiple sclerosis and by familial degenerative myelopathy. In normal subjects, the duration of the silent period is shorter in the upper limbs than in the lower limbs. In patients with spinal compression and multiple sclerosis, the duration of the silent period in the lower limb is significantly greater.

Anterior interosseous nerve syndrome.

Weakness of the flexor pollicis longus, flexor digitorum profundus and pronator quadratus is usually related to an isolated paralysis of the anterior interosseous nerve in the volar aspect of the forearm. The same syndrome may be caused by lesions of the median nerve in the supracondylar region and by involvement of the fibers assigned to the abovementioned nerve in the medial and lateral cords of the brachial plexus. We report 4 cases of the anterior interosseous nerve syndrome (3 spontaneous and one traumatic), review and discuss etiological factors, clinical features and electromyographic findings in the syndrome.

Segmental abdominal zoster paresis.

A case of uncommon feature of herpes zoster, a segmental abdominal paresis, is described. The importance of searching a motor defect in the thoracoabdominal segments and the utility of the electromyographic examination are stressed.

Spasmophilia: a clinical neurophysiopathological and biochemical study.

Spasmophilia is a problem much debated as regards its nosographic location. Its paroxysmal onset in a "neurotic" patient has confined spasmophilia within a psychiatric syndromic complex for many years. In the present study, strict clinical criteria used in selecting a population of spasmophilic patients included clinical, neurophysiological, biohumoral and psychological evaluations, providing further information about the real organic features of this syndrome.

The pronator teres syndrome. Clinical and electrophysiological features in six surgically verified cases.

Six surgically verified cases of pronator teres syndrome are reported. The anatomy of the median nerve at the upper third of the forearm, the relationships between the nerve and the pronator teres muscle and the serial innervation of the muscles of the forearm supplied by the n. medians are described.

Early somatosensory evoked potentials in supratentorial brain tumors.

Early somatosensory evoked potentials were recorded in 33 patients with supratentorial brain tumors (9 benign tumors, 17 glioblastomas and 7 metastases). All the cases were studied with CT scan and all but 2 were surgically explored and histologically classified. Evoked potentials were statistically analyzed regarding the nature and site of the tumors.

Pseudoclaudication in lumbar disc protrusions. Contribution in understanding the etio-pathogenetic factors of the syndrome and surgical results in eight cases.

Eight cases of pseudoclaudication in patients with herniated lumbar discs are reported. Clinical features and variations in clinical patterns are briefly described. The hypotheses concerning the mechanisms causing pseudoclaudication, formulated by some authors, are discussed.