Posterior lumbar plexus block.
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Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history.
A case is described of a young man who presented with acute pulmonary edema and flaccid paralysis of the right upper and lower extremity, following his first injection of heroin and was found in a comatose state. Needle electromyographic findings were compatible with a severe lesion of the right brachial plexus and a moderate lesion of the right lumbar plexus. An allergic or a hypersensitivity reaction might have been the possible cause.
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Newcastle disease (ND) in juvenile double-crested cormorants (Phalacrocorax auritus) occurred several times since 1975, but there are relatively few studies on its pathology and diagnosis. In order to describe the distribution of Newcastle disease virus (NDV) and associated lesions in cormorants with ND and to compare diagnostic methods, 25 cormorants with nervous signs from a ND epizootic in Saskatchewan in 1995 (NDE cormorants) were compared with 18 negative control cormorants. Tissues of these birds were examined by necropsy, histology, virus isolation, immunohistochemistry, serology, and reverse transcriptase-polymerase chain reaction (RT-PCR) methods. The NDE cormorants had a characteristic non-suppurative encephalomyelitis, with a significantly higher prevalence of neuronal necrosis, gliosis, perivascular infiltration with mononuclear cells, and endothelial hypertrophy than control cormorants. These lesions were found more frequently in the cerebellum and brain stem than in other parts of the central nervous system. Immunohistochemically, NDV antigen was limited to neurons, glial and endothelial cells in the central nervous system, and to tubular epithelial cells in the kidney. Newcastle disease virus was isolated with the highest prevalence (4/5) and the highest concentration (10(4.8) ELD50/g) from the kidney. The virus isolates often did not agglutinate erythrocytes in the standard hemagglutination test; the presence of NDV was confirmed by use of an indirect immunoperoxidase assay. By RT-PCR, NDV was detected in kidney and jejunum of a NDE cormorant. There was no significant difference between sensitivity of histology, virus isolation, and serology for detecting ND in NDE cormorants.
The diagnosis of primary neuritic leprosy (PNL) and its differentiation from other causes of peripheral neuropathy is difficult since acid-fast bacilli (AFB) smears and skin biopsy are negative from anesthetic areas. A biopsy of the involved nerve is the only conclusive method of diagnosis. Such a biopsy may not necessarily be free of complications when a large nerve is involved. However, fine needle aspiration has in this study proved to be a simple technique to demonstrate inflammation granulomas and AFB from these involved nerves in 18 of the 27 cases suspected to have PNL. The validity of the cytological classification into morphological subtypes may have to be supplemented by a large series of studies.
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For the studies 4 sexually mature cows were used, in which ovaria and oviducts were cut out bilaterally or unilaterally. The fourth cow was the control of the experiment. The operated animals were kept alive for 21 days and then slaughtered. For studies were taken: the brain stem, spinal cord from the segments Th9 - Th13 and L1 - S4, bilateral spinal ganglions, bilaterally the sympathetic chain from the segment Th10 - S4, and also ganglions and visceral-plexi, anterior mesenteric, intermesenteric, posterior mesenteric, hypogastric and pelvic. The material was fixed in alcohol, embedded in paraffin and cut into 15 micron sections. The sections were stained by Nissel's method. For examinations subsequent sections were taken. Due to the operations performed degeneration changes occurred in nervous cells in the central and peripheral nervous system. They were the basis for determination of the localization of the nervous centres for ovarium and oviduct. The source of preganglionic sympathetic visceromotor fibres for these organs is nucleus intermediolateralis in the segment L2 - L3. The sympathetic postganglionic fibres originate from cells of the sympathetic chain from L1 to L3 and from the posterior mesenteric ganglion and hypogastric plexus. The source of parasympathetic fibres for ovarium and oviduct are cells of nucleus parasympathicus nervi vagi in the segment located somewhat posteriorly from obex. The source of viscerosensory fibres for the discussed parts of the sexual organs in the cow are cells of the spinal ganglions in the segment Th9 - Th13 and cells of nucleus tractus spinocerebellaris dorsalis localized in neuromers L2 and L3.
Conduction blocks have important advantage over spinal blocks for unilateral low extremity surgery in children. The complexity of innervation compared with upper limb is more apparent than real and a good understanding of fascial diffusion spaces is as essential as it is of neural pathways. Useful techniques can be classified into two groups, proximal blocks and distal blocks. Beside emergency situations, proximal blocks are usually performed under light general anaesthesia, with the aid of a neurostimulation. The most used proximal blocks are the femoral block, the sciatic nerve block and to a lesser degree the lumbar plexus direct blockade. Distal blocks can complete a non quite satisfactory proximal block, or be effected so as to obtain analgesia in a limited area (in a cooperative vigil patient). Some of these consist of several anaesthetic subcutaneous infiltrations for which no costly material nor special dexterity are required. A judicious choice among the main available techniques allows an excellent analgesia with a very low cost and almost no risks.
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