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OBJECTIVE: To describe the sonomorphological changes and appearance of deep endometriosis (DE) affecting the nervous tissue of the sacral plexus (SP). METHODS: This was a retrospective study of symptomatic patients who underwent radical resection of histologically confirmed DE affecting the SP and who had undergone preoperative transvaginal sonography (TVS) between 2019 and 2023. Lesions were described based on the terms and definitions of the International Deep Endometriosis Analysis (IDEA), International Ovarian Tumor Analysis (IOTA) and Morphological Uterus Sonographic Assessment (MUSA) groups. A diagnosis of DE affecting the SP on TVS was made when the sonographic criteria of DE were visualized in conjunction with fibers of the SP and the presence of related symptoms corresponding to sacral radiculopathy. Clinical symptoms, ultrasound features and histological confirmation were analyzed for each patient included. RESULTS: Twenty-seven patients with DE infiltrating the SP were identified in two contributing tertiary referral centers. Median age was 37 (range, 29-45) years and all patients were symptomatic and presented one or more of the following neurological symptoms: dysesthesia in the ipsilateral lower extremity (n = 17); paresthesia in the ipsilateral lower extremity (n = 10); chronic pelvic pain radiating in the ipsilateral lower extremity (n = 9); chronic pain radiating in the pudendal region (n = 8); and motor weakness in the ipsilateral lower extremities (n = 3). All DE lesions affecting the SP were purely solid tumors in the posterior parametrium in direct contact with, or infiltrating, the S1, S2, S3 and/or S4 roots of the SP. The median of the largest diameter recorded for each of the DE nodules was 35 (range, 18-50) mm. Echogenicity was non-uniform in 23 (85%) of the DE nodules, with all but one of these nodules containing hyperechogenic areas. The shape of the lesions was irregular in 24 (89%) cases. Only one lesion exhibited a lobulated form, with all other irregular lesions showing a spiculated appearance. An acoustic shadow was produced in 20 (74%) of the nodules, all of which were internal. On color or power Doppler examination, 21 (78%) of the nodules showed no signal (color score of 1). The remaining six (22%) lesions showed a minimal color content (color score of 2). According to pattern recognition, most DE nodules were purely solid, non-uniform, hypoechogenic nodules containing hyperechogenic areas, with internal shadows and irregular spiculated contours, and were poorly vascularized on color/power Doppler examination. CONCLUSION: The ultrasound finding of a parametrial, unilateral, solid, non-uniform, hypoechogenic nodule with hyperechogenic areas and possible internal shadowing, as well as irregular spiculated contours, demonstrating poor vascularization on Doppler examination in proximity to or involving the structures of the SP, indicates DE affecting the SP. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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OBJECTIVE: To investigate the feasibility of identifying and measuring the normal sacral plexus (SP) on gynecological transvaginal ultrasound (TVS) examination. METHODS: This was a prospective observational study conducted at a single tertiary gynecological referral center, including consecutive women undergoing TVS for various indications between November 2021 and January 2022. A standardized assessment of the pelvic organs was performed and the presence of any congenital or acquired uterine pathology or ovarian abnormality was recorded. Visualization of the right and left SP was attempted in all cases. The success rate and the time needed to identify the SP were recorded and measurements of the SP were made. RESULTS: A total of 326 patients were included in the study. In all women, the SP was identified successfully on at least one side. SP were visualized bilaterally in 317 (97.2% (95% CI, 94.4-98.5%)) women. Only the right SP was seen in 3/326 (0.9% (95% CI, 0.2-2.7%)) and only the left in 6/326 (1.8% (95% CI, 0.6-4.0%)) (P = 0.5048). There was no significant difference in the median time required to visualize the right vs left SP (9.0 (interquartile range (IQR), 8.0-10.0) s  vs 9.0 (IQR, 8.0-10.0) s; P = 0.0770). The median transverse diameter of the right SP was 15.0 (IQR, 14.2-15.6) mm and that of the left SP was 14.9 (IQR, 14.4-15.6) mm. CONCLUSIONS: We describe a novel method which allows for the consistent and rapid identification of the SP on TVS. Integrating assessment of the SP into routine pelvic TVS may be helpful particularly for women suffering from deep endometriosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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PURPOSE: The aim of this study was to assess different aspects of reliability in high-resolution ultrasonography (HRUS) of the peripheral nerves and to establish reference values for the most frequently examined nerve segments. MATERIALS AND METHODS: A nerve size parameter, the cross-sectional area (CSA) of the C5, C6 and C7 cervical roots, the median, ulnar, radial, superficial radial, peroneal, tibial, and the sural nerves was measured using HRUS at a total of 14 predefined anatomical sites in two different cohorts of healthy subjects (n = 56), and the inter-rater, intra-rater and inter-equipment reliability of measurements was assessed. RESULTS: The mean CSA of the 14 nerve segments ranged from 2 to 10 mm(2). The intra-rater, inter-rater and inter-equipment reliability was high with intraclass correlation coefficients of 0.93, 0.98, and 0.86, respectively. The CSA values showed no consistent correlation with age, height, and body weight, but males had significantly larger values than females for nerve segments on the arm after correcting for age, weight and height in multivariate analysis. CSA values did not differ when two independent cohorts were compared. CONCLUSION: Peripheral nerve ultrasonography is a reliable and reproducible diagnostic method in the hands of experienced examiners. Normal values for several upper and lower extremity nerves are provided by our study.

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Miller Fisher syndrome (MFS), a variant of the Guillain-Barré syndrome (GBS), is characterized by ophthalmoplegia, ataxia, and areflexia. The annual incidence is around one patient per one million population. The antiganglioside anti-GQ1b IgG antibody has a role in the pathogenesis of the syndrome, especially of ophthalmoplegia. The presence of this antibody in the serum can be identified in over 80% of the patients, peaking in the first week, whereas albuminocytological dissociation in the cerebrospinal fluid (CSF) appears later. The most consistent electrophysiological findings in MFS are reduced sensory nerve action potentials and absent H reflexes. More variability is seen with F waves and various investigations involving cranial structures. Although there are usually no abnormalities in MFS by routine neuroimaging, in a few cases, contrast enhancement of nerve roots and signs of central nervous system involvement were described supporting the hypothesis of an anti-GQ1b-syndrome, a continuum involving GBS, MFS, and Bickerstaff's brainstem encephalitis. Owing to the lack of randomized trials, treatments used for GBS (intravenous immunoglobulin and plasmapheresis) are usually applied, although from retrospective analyses, the outcome was similar between treated and untreated subjects. The outcome of MFS is usually good with case fatality of < 5%. In the few autopsy cases, macroscopic abnormalities were generally not seen in the nervous system. Microscopic examination of the peripheral nervous system (including cranial nerves) showed segmental demyelination with minimal perivascular infiltration with normal spinal cord and brain stem.

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OBJECTIVE: A five-year follow up of patients with epilepsy to examine the change in their oral health and seizure condition. BASIC RESEARCH DESIGN: A prospective observational controlled epidemiologic study under natural treatment settings. PARTICIPANTS: The epilepsy group consisted wholly of patients participating in an epidemiologic survey performed five years previously. The gender- and age-matched control (non-epilepsy) group consisted partly of subjects recovered from the previous study, and partly of new subjects. INTERVENTIONS: Data pertaining to the disease were collected and a thorough dental examination was performed. MAIN OUTCOME MEASURES: Indices quantifying oral hygiene, the number and condition of the remaining teeth and periodontium, and the degree of prosthetic treatment were measured. Statistical comparison was performed between the patient and the control group of the present study, and pair wise between the previous and the present survey. RESULTS: The epileptic condition of the patients showed significant improvement upon follow-up, in contrast to a significant deterioration in their oral health as compared to the control group. Concerning oral health, dental indices describing oral hygiene and periodontal condition showed the most pronounced decline. CONCLUSIONS: The improvement in the epileptic condition of patients is attributed to changes in treatment strategies. As the epileptic condition and oral health of patients changed in opposite directions, socioeconomic and educational factors appear to play a more important role in the poor oral health of these patients than disease-specific factors (e.g. oral cavity injuries, increased exertion on the teeth, antiepileptic drug effects). Furthermore, the periodontal condition seems to be main factor responsible for the unfavourable dental status.

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Vestibular evoked myogenic potential (VEMP) assesses the sacculo-spinal pathway. The aim of our study was to examine sensitivity and factors determining abnormality of VEMP, indicative of brainstem dysfunction, in patients with multiple sclerosis (MS). Thirty healthy subjects and 30 MS patients were examined. All healthy subjects showed a normal biphasic response. Twelve of the 30 MS patients (40%) had abnormal recordings. There was a significant difference between MS patients and control subjects with respect to P13 latency (longer in the MS group) and P13-N23 amplitude (lower in the MS group). VEMP abnormalities were statistically significantly related to the presence of brainstem demyelinative lesions and a weaker correlation was found with disease duration. Clinical signs of vestibular dysfunction at any point during the course of the disease did not seem to affect the chances of obtaining abnormal VEMPs. Although the sensitivity of VEMP in detecting abnormality in MS patients is relatively low, its significance is evident in that it is the only electrophysiological method that is able to detect dysfunction in central vestibular pathways.

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About 15% of human prion diseases are inherited, and are associated with point or insertional mutations of the prion protein gene (PRNP). Four families with six octapeptide repeat insertions (OPRI) in the PRNP gene have been described in the literature so far. Here we report two cases in a Hungarian family with a new six OPRI (R1R2R2R3R2R3gR3R2R2R3R4) in the PRNP gene. The clinical features (progressive ataxia, dementia and anosmia), the age of onset and the duration of disease were almost identical. In addition to the cerebellar and parahippocampal pathological changes already described, we also found deposits of pathological prion protein in the olfactory system.

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Myelopathy secondary to cervical spondylosis is often a difficult clinical diagnosis. Furthermore, with the introduction of magnetic resonance imaging (MRI) an increasing number of patients are identified with spondylotic cervical spinal cord compression. We analyzed the value of functional assessment of the spinal cord by motor and sensory evoked potentials (MEP and SEP) in the detection of myelopathy, with special emphasis on the correlation of clinical and electrophysiological findings. Fifty-one patients with at least some degree of spinal cord compression because of cervical spondylosis, as shown by MRI, were included in the study, grouped according to clinical symptoms. We found that patients who had no clinical symptoms whatsoever indicating myelopathy (they were referred to MRI examination mostly because of cervical radiculopathy), had in the large majority normal MEP and SEP findings. Patients with slight, unspecific and non-confirmative symptoms without pyramidal signs had mostly abnormal MEP but normal SEP findings. This points to the superior sensitivity of MEP over SEP in detecting myelopathy in its early stages. Patients with obvious clinical signs of myelopathy, including pyramidal signs had both abnormal MEP and SEP findings. Altogether these findings may help clinicians in interpreting MRI signs of cervical spinal cord compression.

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Epileptic patients seem to have generally poorer dental condition in comparison with the healthy population for many reasons. It is important to endeavor to provide the same dental care to epileptic patients than to others, however certain factors in connection with their disease must be taken into consideration. Among these, the most important is to concern about the type of seizure with special emphasis on the involvement of the masticatory apparatus and the chances of oral soft tissue injuries and aspiration. In addition seizure frequency and patients' mental compliance might also play a decisive role. According to these factors epileptic patients were grouped into four categories with special regard to their dental manageability from the prosthodontic point of view. The planning of their dental prosthesis was carried out according to the Fábián-Fejérdy classification like in case of any other healthy patients.

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Task-dependent differences in the facilitation of motor evoked potentials (MEPs) following cortex stimulation were studied in a proximal (deltoid) and a distal muscle (abductor digiti minimi; ADM) in 23 healthy subjects during both dynamic and steady contractions of the target muscle under isometric and under nonisometric conditions. In the deltoid, MEP amplitudes were significantly greater if stimulation was performed during dynamic contractions than during steady contractions, despite equal background electromyographic levels just prior to the stimulus. The same task-specific extra facilitation of deltoid MEP amplitudes was also found with magnetic stimulation of the brain stem instead of the cortex in 3 subjects. In the ADM, no such task-dependent extra facilitation of MEPs during dynamic contractions was found. It is concluded that in the deltoid, during dynamic contractions, a greater proportion of the spinal motoneurons is close to depolarization threshold (greater "subliminal fringe") whereas the number of firing motoneurons is similar to that during steady contraction. The lack of task-dependent extra facilitation of MEPs in the ADM is explained by the predominant recruitment principle for force gradation in small hand muscles, which is in contrast to the predominant frequency principle used in proximal muscles.

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The effect of glimepiride (CAS 93479-97-1) on the electrical threshold, conduction time, effective refractory period and automaticity of left atrium and right ventricle in the isolated rabbit heart was investigated and compared with those of chlorpropamide and glibenclamide. From the sulphonylureas investigated only glibenclamide diminished the electrical activity of rabbit heart muscle preparations. Chlorpropamide and glimepiride have a mild effect to change the basic parameters on the opposite direction. It seems that glimepiride does not have a significant effect on cardiac muscle in vitro.

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The aim of this study was to clarify whether or not arachidonic acid metabolic disorders are caused by a substrate inavailability and whether such disorders might contribute to circulatory disturbances in the diabetic myocardium. Norepinephrine induced a decrease in the conductivity of both coronary arterial bed and myocardial microcirculation in alloxan-diabetic dogs. It was markedly (p less than 0.05) attenuated both by indomethacin and acetylsalicylic acid pretreatments indicating an imbalance among the vasoactive prostanoids in diabetes. TXA2 release from the diabetic coronary rings was found to be elevated and could be normalized after the blockade of vascular adrenoceptors by phentolamine (p less than 0.05). PGI2 synthesis was also enhanced by adrenergic blockade in the diabetic arterial rings. After pretreatment with 14C arachidonic acid, in order to measure substrate availability, the arachidonic acid metabolic rate was less in the diabetic coronary arteries than in healty vessels (p less than 0.05). Ten mumol/l norepinephrine decreased arachidonic acid metabolism in the presence of prelabelled substrate in the diabetic animals, compared to an increase observed in metabolically healthy dogs. Therefore diabetes appears to diminish arachidonic acid metabolism and uptake independent of adrenoceptors and to induce an imbalance between vasoconstrictor and vasodilator cyclooxygenase products, resulting in elevated TXA2 release controlled by adrenergic mechanisms which may contribute to an impairment in myocardial microcirculation.

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A retrospective study was performed on 1040 diabetic patients. The survival time of those treated with first generation sulphonylureas (n = 227) was considerably (P < 0.001) shorter after the first attack of angina pectoris (5 +/- 1 years, mean +/- S.E.) or acute myocardial infarction (6 +/- 1 years) than of those (9 +/- 1 years) on glibenclamide treatment (n = 144), with regime alone (n = 282) or treated with insulin (n = 387). The systolic blood pressure of patients with first generation sulphonylureas (166 +/- 1/91 +/- 1 mmHg) proved to be higher (P < 0.01) than those treated with glibenclamide (159 +/- 1/91 +/- 1 mmHg) or being on regime alone (155 +/- 1/89 +/- 1 mmHg) or on insulin (156 +/- 1/89 +/- 1 mmHg) treatments. Serum sodium level was found to be lower (P < 0.05) in patients treated with any kind of sulphonylureas (138 +/- 1 mmol/l) than in the other patients (143 +/- 1 mmol/l). During an observation period, 576 of patients died, 412 of them due to cardiovascular or renal failures. Among the diabetic subjects suffering from coronary heart disease no difference could be detected in risk factors except for higher systolic blood pressure. The shorter survival time of patients treated with first-generation sulphonylureas might be explained by the arrhythmogenic activity of first-generation sulphonylureas. Improvement in therapy, metabolic and cardiovascular alterations during the survey can not be responsible for the shorter survival time of patients treated with first generation-sulphonylureas.

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A previously healthy 25 year old sportsman is reported who developed Corynebacterium xerosis meningitis with coma and seizures after spinal anaesthesia. The adequate therapy (dexamethason, penicillin, ampicillin, mannitol, intensive care, hyperventillation) resulted in a complete recovery. To the authors' knowledge this is the first case of Corynebacterium xerosis meningitis and the first bacterial meningitis reported after spinal anaesthesia in Hungary.

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We tested the effect of exogenous purine derived free radicals and H2O2 vs ischemia and reperfusion on the thiobarbituric-acid (TBA)-reactive material and malondialdehyde (MDA) formation in isolated rat hearts using the thiobarbituric acid test and high performance lipid chromatography (HPLC). We could not detect increased thiobarbituric-acid-reactive material or MDA production during 6 mM H2O2 infusion, during free radical generation by purine-derived free radicals, or using ischemia and reperfusion. Increased thiobarbituric-acid-reactive material and MDA tissue levels were detected only during infusion of 12 mM H2O2 (p less than 0.001). We conclude that the generally used thiobarbituric acid assay for MDA is susceptible to artifacts and unsuited as an indirect measure for low-to-medium-levels of oxygen free radicals. Using HPLC assay, which accurately measures MDA, no evidence was found that MDA is a primary and direct lipid peroxidation product of exogenous or endogenous reactive oxygen species.

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The effects of first generation sulphonylurea compounds carbutamide, gliclazide and tolbutamide as well as second generation compounds glibenclamide and glipizide on the cardiovascular system were investigated in dogs. Six dogs received each compound intravenously at cumulative dose levels of 74, 296, 1184 mumol/kg of carbutamide and tolbutamide, 0.4, 2.0, 10.0 mumol/kg of glibenclamide and glipizide, and 16, 48 and 144 mumol/kg of gliclazide. Mean arterial blood pressure, myocardial contractile force, cardiac output and heart rate were measured. The rate of change of myocardial contractile force development (positive dF/dt), as well as of myocardial relaxation (negative dF/dt) were measured. The first generation sulphonylureas were found, in dogs, to exert a positive inotropic effect in contrast to second generation compounds. The clinical importance of our findings may be in the potential for the malfunction of the cardiovascular system (based on cardiopathy, neuropathy, atherosclerosis, and obesity), developing in diabetes, to be further impaired by the first generation sulphonylureas. Therefore, second generation sulphonylureas should be preferred in the therapy of type 2 diabetics, if satisfactory metabolic control cannot be achieved by dietary management alone and sulphonylurea treatment becomes necessary.

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In a retrospective study of 962 diabetic (male: 441, female: 521) patients in the Diabetic Outpatient Clinic of the National Institute of Cardiology between 1st November 1967 and 31st October 1988 the survival time of diabetics treated with first generation sulphonylureas was considerably less after the first attack of angina pectoris or acute myocardial infarction compared with that of individuals controlled with regime alone or being on glibenclamide or insulin treatments. The systolic blood pressure proved to be higher in diabetics treated with first generation sulphonylureas. During the observation, among the 183 patients on insulin- as well as in the 262 individuals on first and 230 on second generation sulphonylurea treatments, and in the 287 diabetics controlled with regime alone, 547 (male: 241, female: 306) patients died, 403 of them due to cardiovascular and renal failures. Between the diabetics suffering from ischaemic heart diseases no difference could be detected relating the risk factors except the higher systolic blood pressure. The alterations in the cardiovascular states during the survey, the improvement of therapeutical interventions, the alterations in the carbohydrate and lipid metabolism are not supposed to be involved in the shorter survival time of diabetics treated with first generation sulphonylureas. The shorter survival time might be explained by the arrhythmogenic activity of first generation sulphonylureas described in earlier studies. On this basis we are tempted to draw the conclusion that second generation sulphonylureas must be selected in the diabetes care, if the metabolic state could not be normalized by diet and regime only.

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The effects of first and second generation hypoglycemic sulfonylureas on the incidence of ventricular ectopic beats and on the duration of transitional ventricular fibrillation in the ischemic rat heart were investigated. First generation sulfonylurea compounds (tolbutamide, carbutamide and gliclazide) in 105 preparations increased, while second generation sulfonylurea compounds (glibenclamide and glipizide) in 50 preparations decreased in a dose-dependent manner both the number of ventricular ectopic beats and the duration of transitional ventricular fibrillation during the first 30 min after ligation of the left anterior descending coronary artery. Therefore, second generation sulfonylureas should be preferred in the treatment of type 2 diabetics with ischemic heart diseases, if satisfactory metabolic control cannot be achieved by a treatment regimen and diet alone.

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