Comparative study between intra-anal sponge and needle electrode for electromyographic evaluation of constipated patients.

Purpose: The aim of this study was to compare the intra-anal sponge electrode with the conventional needle electrode for electromyography of the pelvic floor in constipated patients.

Materials And Methods: Forty consecutive patients (27 females) with a mean age of 64.3 (range, 15-87) years who had chronic constipation were prospectively evaluated for electromyographic evidence of nonrelaxation or paradoxical contraction of the puborectalis and external anal sphincter during simulated defecation.

Proposed algorithm to aid the diagnosis of cerebellopontine angle tumors.

Hearing and/or balance disorders are symptoms that may be associated with tumors of the cerebellopontine angle (CPA). Between March 1988 and May 1995, 22 patients had diagnosis or evaluation of CPA tumors at Cleveland Clinic Florida. The most common presenting signs or symptoms included unilateral low-frequency tinnitus, unsteadiness, and/or asymmetric hearing loss.

Variation in pudendal nerve terminal motor latency according to disease.

Purpose: The aims of this study were first to establish whether any difference among pudendal nerve terminal motor latency (PNTML) values exists relative to diagnosis, second to determine whether left and right latencies are similar, and third to assess any correlation between age and neuropathy. Latency was elicited three times on each side, and an average latency was recorded as a result.

Materials And Methods: Between June 1989 and April 1995, 1,026 patients (775 females and 251 males) underwent PNTML study.

Pudendal neuropathy is not related to physiologic pelvic outlet obstruction.

Unlabelled: Chronic straining because of pelvic outlet obstruction is hypothesized to cause pudendal neuropathy (PN) by stretch injury.

Purpose: The aim of this study was to determine any association between PN and pelvic outlet obstruction.

Methods: One hundred forty-seven constipated patients were evaluated by cinedefecography and pudendal nerve terminal motor latency assessment.

Electrodiagnostic evaluation of fecal incontinence.

The aim of this study was to assess the utility of electrodiagnostic testing (EDT) for the evaluation of fecal incontinence (FI). Over a 5-year period, 225 patients (174 females) with FI were prospectively studied with anal manometry, anal ultrasonography, anal electromyography (AEMG), and pudendal nerve terminal motor latency (PNTML) assessment. The mean age was 60 (range 12-94) years.

Pudendal neuropathy in evacuatory disorders.

Purpose: Aims of the present study were to assess frequency of pudendal neuropathy in patients with constipation and fecal incontinence, to determine its correlation with clinical variables, anal electromyographic assessment, and anal manometric pressures, and to determine usefulness of the pudendal nerve terminal motor latency assessment in evaluation of these evacuatory disorders.

Methods: From 1988 to 1993, 395 patients (constipated, 172; incontinent, 223) underwent pudendal nerve terminal motor latency, electromyography, and anal manometry. Pudendal neuropathy was defined as a pudendal nerve terminal motor latency greater than 2.

Role of pudendal nerve terminal motor latency assessment in constipated patients.

Unlabelled: The importance of pudendal nerve terminal motor latency assessment for the evaluation of incontinence is well established. However, its role in constipated patients remains unclear.

Purpose: The purpose of the present study was to assess the incidence of pudendal neuropathy in constipated patients and its correlation with others variables including age, sex, anal pressures, and anal electromyography.

Anorectal manometry in the diagnosis of paradoxical puborectalis syndrome.

This prospective study was undertaken to compare the utility of anorectal manometry (ARM) with that of anal electromyography (EMG) and cinedefecography (CD) in the diagnosis of paradoxical puborectalis syndrome (PPS). One hundred sixteen consecutive patients with a history of chronic constipation were prospectively assessed. These 35 males and 81 females were of a mean age of 60 years, ranging from 18 to 84 years.

Cinedefecography and electromyography in the diagnosis of nonrelaxing puborectalis syndrome.

A prospective study was undertaken to assess the correlation between electromyography (EMG) and cinedefecography (CD) for the diagnosis of nonrelaxing puborectalis syndrome (NRPR). Clinical criteria for NRPR included straining, incomplete evacuation, tenesmus, and the need for enemas, suppositories, or digitation. EMG criteria included failure to achieve a significant decrease in electrical activity of the puborectalis (PR) during attempted evacuation.

Neurophysiologic assessment of the anal sphincters.

One hundred twenty consecutive patients with either fecal incontinence (60 patients), chronic constipation (41 patients), or idiopathic intractable pelvic pain (19 patients) were prospectively assessed. Patients underwent concentric needle electromyography (EMG), bilateral pudendal nerve terminal motor latency evaluation, anorectal manometry, and cinedefecography. The most common EMG finding in patients with fecal incontinence was decreased recruitment of motor units with squeezing and polyphasic motor unit potentials; these are consistent with an injury pattern.

Phenelzine toxicity responsive to dantrolene.

We describe a 44-year-old man with signs of phenelzine sulfate (a monoamine oxidase inhibitor) toxicity, including coma, hyperpyrexia, hypotension, tachycardia, generalized muscular rigidity, and hyperreflexia. He recovered after IV treatment with dantrolene. Dantrolene appears to be an effective treatment for phenelzine toxicity manifested by a hypermetabolic state.

Thyrotropin-releasing hormone (TRH) in murine motor neuron disease (the wobbler mouse).

Clinical benefits of thyrotropin-releasing hormone (TRH) were tested in wobbler mice, an animal model of motor neuron disease. After the disease was clinically recognized at 3-4 weeks, the animals were divided into two groups, each group consisting of 5 pairs of wobbler mice and normal littermates. TRH (50 mg/kg) and normal saline (NS) were injected intraperitoneally daily, 6 times per week for 9 weeks, in a double-blind study.

Acute arsenic intoxication presenting as Guillain-Barré-like syndrome.

Arsenic-induced polyneuropathy is traditionally classified as an axonal-loss type, electrodiagnostically resulting in low amplitude or absent sensory and motor responses, relatively preserved proximal and distal motor conduction rates, and distal denervation. We report four patients with a subacute onset progressive polyradiculoneuropathy following high-dose arsenic poisoning. In three patients, early electrodiagnostic testing demonstrated findings suggestive of an acquired segmental demyelinating polyradiculoneuropathy.

Amyotrophic lateral sclerosis: effects of acute intravenous and chronic subcutaneous administration of thyrotropin-releasing hormone in controlled trials.

We performed double-blind crossover trials to assess the effects of thyrotropin-releasing hormone (TRH) on amyotrophic lateral sclerosis patients. For acute intravenous trials, 500 mg TRH or placebo with norepinephrine was given at 1-week intervals (16 patients). CSF TRH concentration increased, and clinical side effects appeared with TRH.

The second sensory area in humans: evoked potential and electrical stimulation studies.

A patient with intractable seizures originating from a right frontal focus was evaluated for surgical treatment. This evaluation was carried out using a chronically implanted array of 96 stainless steel electrodes 1 cm apart and covering the perirolandic and frontal areas. Somatosensory evoked potentials and electrical stimulation of the subdural electrodes localized the primary sensory hand area.

Focal inflammatory myopathy.

We report three patients with inflammatory myopathy who presented clinically with weakness and wasting of only one limb. The myopathy progressed over 6 months and 5 years, respectively, in two patients and was stable after 8 years in the third patient. One patient had a skin rash.

Adult-onset acid maltase deficiency presenting as diaphragmatic paralysis.

A 51-year-old man presented with a six-year history of gradually progressive exertional dyspnea. His complaint was attributed to increasing age, but evaluation finally led to a diagnosis of diaphragmatic paralysis. Neurological examination disclosed only minimal evidence of weakness of limb muscles.

Hashimoto's thyroiditis, primary biliary cirrhosis, and myasthenia gravis.

A previously undescribed triad of autoimmune diseases--Hashimoto's thyroiditis, myasthenia gravis, and primary biliary cirrhosis--is reported. A possible common cell-mediated immune disorder is postulated.

Metastatic prostatic adenocarcinoma to the temporal bone.

A patient had paralysis of multiple lower cranial nerves (VII, IX, X, XI, and XII) and oculosympathetic fibers, and ipsilateral conductive hearing loss. Histologic analysis of a surgical biopsy of the temporal bone revealed metastatic adenocarcinoma of prostatic origin. This is only the second reported case in the English literature (seventh in the world literature) of prostatic adenocarcinoma metastasizing to the temporal bone.

Traumatic ulnar neuropathy from jet injection: case report.

The usefulness and relative safety of the technique of jet injection, mainly used in mass immunization, have been well established. A patient who developed a traumatic ulnar neuroma at the site of jet injection of swine flu vaccine is reported. This unusual and previously unreported complication of this procedure is thought to have occurred because of the patient's extremely small size and small muscles.

Alexia without agraphia.

This typical case of alexia without agraphia, caused by an astrocytoma, is the first recorded case in the literature of alexia without agraphia with a right homonymous hemianopia caused by a tumor. This case differs from previously reported cases of the syndrome by its fluctuating clinical course and its slow progression. All but one of previously reported cases had been of vascular or surgical etiology.