[PAINFUL SEQUELLAE OF PERIPHERAL NERVE INJURIES. PAINFUL STUMPS].
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Peripheral nerve involvement in the course of neoplastic disease represents a clinically significant complication, with clinical uncertainties raising questions as to its pathophysiology. The aim of this study was the analysis of ATPase activities, lipid peroxidation and sulfhydryl groups in the sciatic nerve of tumor-bearing rats. We investigated also morphometric features of the sciatic nerve of experimental animals. An increase was noted in Na+/K+-ATPase and Mg+2-ATPase activities and elevation of conjugated diene and malonyldialdehyde contents, associated with a decrease in sulfhydryl groups in Morris-hepatoma-bearing rats. The morphometric evaluation revealed myelin sheath thickening, associated with an increase in axon cross-section area and degenerative changes in dorsal horns. In this study, the moderate lipid peroxidation in experimental neoplastic disease was demonstrated to lead to depletion of sulfhydryl groups in the degenerating rat sciatic nerve which was associated with stimulation of ATPase activities.
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The mean latency value of somatosensory evoked potentials (SEP) recorded at the Erb's point, spinal and cortical level, was assessed in 20 normal subjects by percutaneous stimulation of the peripheral nerves (median, ulnar, superficial radial, tibial and peroneal). At the Erb's point and spinal cervical level, we distinguished the classically described potentials (N9, N13, N14) and the cortical "far-field" potentials such as: P17, N20, P24, N35 and sometimes P45. The central conduction time was calculated by determination of the interpeak latency N9-N13 and N13-N20 (for the upper limb) and LP-P37 for the lower one. A study of 100 patients with peripheral nerve diseases: 30 polyneuropathies, 50 radiculopathies, 9 cases with carpal tunnel syndrome, 5 with brachial plexus injury, 6 with compressive or traumatic diseases of the peripheral nerves, demonstrates the value of the SEPs in the assessment of the nervous lesion site (central or peripheral). In polyneuropathies, a decrease in amplitude and delayed latency of the N9 potential as well as delayed latency of the early cortical potentials on stimulation of the median and tibial nerves occurred. Delayed N9 and low amplitude with delayed latency spinal potential (N13 and LP) were found in radiculopathies. In myelopathies, the central spinal conduction time (N9-N13) was delayed and there were also delayed latencies of the cortical SEPs on lower limb stimulation. The patients with brachial plexus injury had a change in the N9 to N13 amplitude ratio, with prognostic value. Cortical recordings of the SEPs are also of special prognostic value and may suggest the surgical exploration when the axonal functional continuity is lost in brachial plexus injury and compressive or traumatic lesions of the peripheral nerves.
PCR analysis of DNA extracted from 31 sections of formalin-fixed sural nerve biopsies did not reveal herpes simplex virus (HSV) DNA. Unlike the presence of HSV DNA sequences in normal human brain, spinal cord, and ganglia, HSV DNA is not present in normal or diseased human distal peripheral nerve.
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Peripheral nerve morphometry was assessed in four patients with Tangier disease. Three patients with a relapsing and remitting multiple mononeuropathy had prominent peripheral nerve demyelination and remyelination with affected internodes clustered along particular nerve fibres. Putative lipid vacuoles were almost exclusively confined in this multifocal neuropathy syndrome to Remak cells. By contrast a fourth patient with a slowly progressive syringomyelia-like neuropathy had advanced peripheral nerve degeneration and a more global distribution of lipid vacuoles within peripheral nerve. A review of Tangier disease in the literature indicated the possibility of additional peripheral nerve syndromes. The clinical heterogeneity raises the possibility of different metabolic errors in Tangier disease or a common metabolic error subject to genetic influences. The results of this study indicate that normal serum cholesterol levels do not exclude a diagnosis of Tangier disease. It is therefore advisable to determine both high density lipoproteins and serum cholesterol levels in patients with undiagnosed multifocal neuropathy or syringomyelia-like syndromes.