Comparison of magnetic coil stimulation and needle electrical stimulation in the diagnosis of lumbosacral radiculopathy.

Electrical stimulation (ES) of lumbosacral nerve roots using a needle electrode inserted to the laminar level at the midline of Th12-L1 or L1-2 intervertebral interspace, was compared with magnetic stimulation using a 9-cm diameter coil (MCS) at the L3-4 or L4-5 spine levels, Compound muscle action potentials (CMAP) were superficially recorded from homologous muscles in both sides in 15 normal control subjects and in 20 patients with lumbosacral radiculopathy. Soleus muscles were used for S1, tibialis anterior (TA) for L5, and rectus femoris (RF) muscles for L4 roots. According to the clinical or radiological diagnosis (CAT, MRI and/or myelography) conventional needle EMG was capable to localise the root lesion in 16 of 20 patients (80%) and ES localised the root involvement in 18 of 20 patients (90%); the diagnostic value of MCS was lower, about 65% (13 of 20 patients).

Subclinical anterior horn cell involvement in juvenile myoclonic epilepsy.

Although clinical signs of muscle wasting and weakness were not present, electromyographic (EMG) evidence of subclinical anterior horn cell involvement of spinal cord was noted in 5 patients with juvenile myoclonic epilepsy (JME). Quantitative interference pattern analysis of EMG recorded from the anterior tibial muscle showed that the ratio (amplitude:turn/turn:second, A:T/T:S) was significantly increased in 10 patients with JME and 12 patients with lower motor neuron disorders (LMND) as compared with those of 22 normal subjects and 15 patients with frequent generalized tonic-clonic seizures (GTC). Subclinical anterior horn cell involvement detected by EMG techniques can be related to a genetically determined component of JME.

Sacral spinal cord and root potentials evoked by the stimulation of the dorsal nerve of penis and cord conduction delay for the bulbocavernosus reflex.

Segmental spinal cord and root potentials in response to stimulations of the dorsal nerve of penis, tibial nerve, and the sural nerve were epidurally recorded in normal subjects. EMG responses from the bulbocavernosus (BC) and the various leg muscles were also recorded in response to bipolar stimulations by the same epidural needle electrodes of the sacral cord and lumbosacral roots. The afferent conduction velocity from the penis to Th12-L1 intervertebral level was about 40 m/sec on the average, which is significantly slower than those obtained by the stimulation of the mixed and cutaneous nerves at the lower limb.

X-linked bulbospinal muscular atrophy (Kennedy's syndrome): a report of three cases.

Two cases of X-linked bulbo-spinal muscular atrophy and one sporadic case with the same clinical features are presented. All three cases were extensively studied by electrophysiological methods. One of the patients showed some transient weakness, which was partly improved by pyridostigmin.

Management of vascular injuries of the extremities. One hundred and fifteen cases.

In between the years 1984-1989, 115 peripheral arterial injuries were admitted to the Emergency Surgical Unit of Istanbul Medical Faculty. Seventy-two patients (62%) had upper extremity and 43 patients (38%) had lower extremity vascular injuries. Twenty-eight of these cases (24%) were due to blunt trauma, angiographic studies were obtained in 26 patients.

[The role of peritoneal lavage in treatment of penetrating abdominal injuries].

Preventing negative laparotomies is one of the most challenging problems in the management of penetrating abdominal injuries. The term "selective laparotomy" has been therefore introduced and has found an ever increasing acceptance. The peritoneal lavage is a useful tool in patient selection for laparotomy but the main problem is where to set the boundary between a positive and a negative peritoneal lavage.

Examination of the descending pathway to the external anal sphincter and pelvic floor muscles by transcranial cortical stimulation.

In 26 neurologically normal patients and 9 healthy volunteers EMG responses after transcranial cortical stimulation (TCCS) were recorded from the external anal sphincter (EAS), the anterior tibial muscle (TA), the bulbocavernosus muscle (BC) and the rectus abdominis muscle (RA). Electrical TCCS was used in 29 subjects and magnetic TCCS in 6 subjects. Response patterns in the different muscles in relation to the strength of the stimulus were analyzed.

[Blunt diaphragmatic rupture in children].

The incidence of traumatic diaphragmatic hernia due to blunt trauma, an uncommon injury in children, has been increased with the increase in automobile and pedestrian accidents. During a 5 year period, 9 patients 3-14 years of age, with acutely ruptured diaphragms following blunt trauma were treated in our institution. Diaphragmatic injury was detected within 6 hours of admission to the hospital.

[Blunt kidney injuries in children].

Trauma, primarily due to traffic accidents, is the most common cause of death in childhood. In the context of abdominal trauma, the probability of injuries to urinary organs in children is higher than in adults. Peritoneal lavage and use of the CRAMS scale have proved to be reliable methods for assessment and planning of therapy for traumatised children.

Sympathetic skin potentials and bulbocavernosus reflex in patients with chronic alcoholism and impotence.

Fifteen chronic alcoholic male patients with impotence have been investigated with the electrophysiological method of sympathetic skin potentials recorded from the genital skin and with the electrically induced bulbocavernosus reflex. Both electrophysiological tests did not differ from those of normal controls. It was proposed that there is no obvious role of the peripheral neuropathic factors in the pathogenesis of impotence in chronic alcoholism.

Cerebral evoked potentials after stimulation of the posterior urethra in man.

Cerebral evoked potentials (EPs) were recorded in 25 neurologically normal subjects aged 22-73 years (mean 44.0) after stimulation of the posterior urethra (PU) and the pudendal nerve. After maximal PU stimulation 2 different configurations of the potential were found.

A neurophysiological study of patients undergoing radical prostatectomy.

24 men suffering from localized prostatic cancer undergoing radical retropubic nerve-sparing prostatectomy were investigated by the following electrophysiological methods: Bulbocavernosus reflexes elicited from the penile skin or the posterior urethra, sensory thresholds in the posterior urethra, cerebral evoked potentials after stimulation of the pudendal nerve or the posterior urethra. 15 men were examined 4-33 months postoperatively only, 5 men were examined only preoperatively and 4 men were examined both pre- and postoperatively. 10 men suffering from minor problems due to benign prostatic hyperplasia served as controls.

Skin potentials (SP) recorded from the extremities and genital regions in normal and impotent subjects.

Skin potentials (SP) were evoked by peripheral nerve stimulation from the hands and feet of 41 and from the genital skin of 28 male, controls. The same methods were also applied in 10 functionally impotent cases, 32 diabetic impotent and 8 diabetic normopotent cases. The SP was easily obtained from all 3 sites in all normal subjects and in 10 functionally impotent cases.

Descending lumbosacral cord potentials (DLCP) evoked by stimulation of the median nerve.

In 22 normal human subjects, descending lumbosacral cord potentials (DLCP) were recorded intrathecally after stimulation of the median nerve at the elbow. The onset of DLCP is very short in latency (mean 12.1 ms) with a prominent sharp early positive peak (mean latency 13.

The value of somatosensory-evoked potentials and bulbocavernosus reflex in patients with impotence.

In 14 normal male adults and 97 male patients having impotence alone or together with systematic and/or neuro-psychiatric symptoms and signs, the somatosensory cerebral-evoked potentials were obtained by glans penis stimulation (penile SEP); by peroneal nerve stimulation (peroneal SEP) and by electrically-induced bulbocavernous (BC) reflex. In normal subjects, the configurations of both SEPs were basically similar, except that the onset of latency was 10-15 msec longer and the amplitude in the P1-N1 component was higher in penile SEP. BC-reflex latency was abnormally prolonged, especially in diabetic impotence and in patients with cauda/conus lesions, while the abnormalities on the penile and peroneal SEP were more frequent in patients with spinal cord injuries.

Somatosensory cerebral potentials evoked by stimulation of the lumbo-sacral spinal cord in normal subjects and in patients with conus medullaris and cauda equina lesions.

Somatosensory cerebral evoked potentials were recorded by intrathecal stimulation of the lumbo-sacral cord and roots in 16 normal subjects and patients having cauda/conus injury (group A, 15 cases), compressive lesions of cauda equina (group B, 13 cases) and lesions of both types covering the lumbar cord (group C, 24 cases). The shape of the intrathecally evoked cerebral potential (IECP) was basically the same as that obtained by posterior tibial nerve stimulation from 12 normal subjects except that the early components were 10-15 msec shorter in latency in the former potential, with an average of 12 msec. IECPs were easily recorded in groups A and B, but a significant delay was found in both groups, especially group A.

Studies on the human spontaneous electromyelogram (EMyeloG). III. Spontaneous spinal cord activity of the cat relevant to the human spontaneous EMyeloG.

The spontaneous electromyelogram (EMyeloG) was investigated in 16 cats, some after laminectomy and some by a percutaneous intrathecal technique similar to the human approach. Small diphasic negative-positive waves at less than 50 microV, with short durations, were consistently recorded from the posterior aspect of the spinal cord in both laminectomized and intact cats. It was demonstrated that this kind of background activity is mainly located within the posterior halves of the spinal cord and is strictly dependent on the peripheral inputs producing excitability changes in the gray matter of the posterior horn.

Studies on the human spontaneous electromyelogram (EMyeloG). II. Patients with peripheral nerve, root and spinal cord disorders.

Using an intrathecal recording technique the spontaneous electromyelogram (EMyeloG) was recorded in 44 patients having peripheral nerve, spinal root and lower motor neurone disorders (17 cases), suprasegmental spinal cord disorders (18 cases) and diffuse involvement of the posterolateral funiculus or spinal ganglia (9 cases). In the first 17 cases, labelled as 'afferent group,' the spontaneous EMyeloG was significantly reduced, parallelling the paucity of afferent signals entering the spinal cord. However, the spontaneous EMyeloG was found to be normal in cases with the diffuse anterior horn cell involvement and motor polyneuropathy.

Studies on the human spontaneous electromyelogram (EMycloG). I. Normal subjects.

Using an intrathecal recording technique, the spontaneous electrical activity (EMyeloG) of the spinal cord was recorded in 25 normal human subjects. Very fast, continuous, irregular activity was analysed from the lumbo-sacral or cervical enlargement of the spinal cord after excluding volume-conducted potentials such as ECG and EMG. It was demonstrated that these spontaneous action potentials could be divided into two basic groups: (a) negative-positive diphasic waves, and (b) positive monophasic or positive-negative diphasic waves.

Reflex erector spinal responses in disorders of the central nervous system.

In 64 patients with various central and peripheral nervous system disorders, the lumbar erector spinal muscle responses evoked by electrical stimulation of the brachial plexus at Erb's point or of the posterior tibial nerve in the popliteal fossa while standing were recorded. These responses were either absent or delayed in patients with involvement of the posterior columns. The latency of the responses was the same in patients with cerebellar syndromes, Parkinsonism, spastic hemiparesis or vestibular ataxia as in normal subjects.

Erector spinae muscle responses while standing.

In 55 normal adult subjects standing erect, stable EMG responses could be recorded from the lumbar erector spinae muscles in response to unilateral sudden are abduction produced by single electrical stimuli applied to the brachial plexus at Erb's point, or to knee and ankle movement produced by stimuli to the posterior tibial nerve in the popliteal fossa.

Bulbocavernosus reflex in benign hypertrophy of the prostate.

Electrically induced bulbocavernosus (BC) reflexes were investigated in 47 patients with benign prostatic hypertrophy and the possible harmful effects of prostatectomy on the pudendal nerve branches were followed up in 30 of the patients using the same method. BC reflex obtained by electrical stimulation of the glans penis did not differ significantly from the normal value in bulbocavernosus and external urethral sphincter muscles whether or not patients had been operated on. It was concluded that there is no reason to believe in the existence of somatic involvement of the pudendal nerve branches in prostatic hypertrophy, or that suprapubic prostatectomy could harmfully affect such somatic nerve fibers.

Electrophysiological evaluation of the afferent spinal roots and nerves in patients with conus medullaris and cauda equina lesions.

The clinical value and practical application of the lumbosacral evoked electrospinogram (Espg) and somatosensory cerebral evoked potentials (SEP) were investigated in 52 patients with conus medullaris or cauda equina lesions. It was shown that the destruction or compression of the conus/cauda equina region by traumatic fracture and dislocation of upper lumbar vertebrae, by midline herniation of the nucleus pulposus and by tumoral mass, produced significant reduction in amplitude and delay in latency of Espg recorded just above the lesion site, and the SEP behaved in a similar way. The degree of abnormality was found to be in accord with the severity of clinical sensorimotor deficits in the legs.

Effect of continuous vibration on sural nerve action potentials.

The effects of continuous vibration on sural nerve action potentials were investigated in 15 subjects. The results show that continuous vibration applied to the sural nerve innervated skin area produces an amplitude reduction of the sural nerve action potentials on both painless and painful stimulation conditions. This amplitude decrease is attributed to an impulse blockage of the large diameter afferent nerve fibers.

Bulbocavernosus reflex in patients with conus medullaris and cauda equina lesions.

The clinical value and practical application of the electrically induced BC reflex was investigated in 40 patients with traumatic or compressive lesions of the conus medullaris or cauda equina. It was shown that the BC reflex was either absent or delayed depending upon the invovlement of the sacral 2--4 spinal and radicular segments. The latency of the BC reflex was normal in patients with mainly epiconus and lumbar cord involvement.