Neurophysiology of the pelvic floor in clinical practice: a systematic literature review.

Neurophysiological testing of the pelvic floor is recognized as an essential tool to identify pathophysiological mechanisms of pelvic floor disorders, support clinical diagnosis, and aid in therapeutic decisions. Nevertheless, the diagnostic value of these tests in specific neurological diseases of the pelvic floor is not completely clarified. Seeking to fill this gap, the members of the Neurophysiology of the Pelvic Floor Study Group of the Italian Clinical Neurophysiology Society performed a systematic review of the literature to gather available evidence for and against the utility of neurophysiological tests. Our findings confirm the utility of some tests in specific clinical conditions [e.g. concentric needle electromyography, evaluation of sacral reflexes and of pudendal somatosensory evoked potentials (pSEPs) in cauda equina and conus medullaris lesions, and evaluation of pSEPs and perineal sympathetic skin response in spinal cord lesions], and support their use in clinical practice. Other tests, particularly those not currently supported by high-level evidence, when employed in individual patients, should be evaluated in the overall clinical context, or otherwise used for research purposes.

Carpal tunnel syndrome: which electrodiagnostic path should we follow? A prospective study of 100 consecutive patients.

We prospectively studied 100 consecutive patients (200 hands) sent to our Neurophysiopathology Service for a suspected Carpal Tunnel Syndrome (C.T.S.). We performed 6 different motor and sensitive electrodiagnostic tests on both hands of each patients and on 25 healthy subjects. We calculated the sensibility and the specificity of each test by comparing each parameter with all the other ones, and then, again, using the clinical evaluation as a "gold standard". The routinely performed tests proved to have a high sensibility in detecting C.T.S., nevertheless, sometimes they do not give a definite response. In these cases we suggest to carry out the neurophysiological examination by performing some of the newly proposed tests. We end our study by drawing a "flow-chart", which considers reliability, sensibility, difficulty in performing and/or evaluating, and discomfort for patients, of each test; by this we would give a guide and a practical aid in determining the electrophysiological path for C.T.S. diagnosis.

Hearing preservation surgery in acoustic neuroma. Slow progress and new strategies.

Quality and rate of preserved hearing are crucial to make hearing preservation surgery a viable treatment. A long-term experience with hearing preservation surgery, with tumour size and hearing as admission criteria, was evaluated to assess which size and hearing allowed a high rate of success. The hearing outcome in relation to size of tumour and pre-operative hearing was retrospectively reviewed in a consecutive series of 115 cases of sporadic acoustic neuroma which were operated on with hearing preservation surgery. Inclusion criteria were hearing with ≤ 30 dB pure tone average and ≥ 70% Speech Discrimination Score. The size was ≤ 15 mm in the first series of 51 cases, and ≤ 10 mm in the second series of 64 cases. Pre-operative and post-operative pure tone average were measured at 0.5 to 4.0 KHz, and speech discrimination score at ≤ 40 dB above perception. Post-operative hearing within 30 dB pure tone average and 70% speech discrimination score was considered socially useful hearing and successful outcome. The change to 40 dB pure tone average and 60% speech discrimination score from a pre-operative 30 pure tone average/70% speech discrimination score was considered an acceptable outcome. Patients with a tumour of ≤ 10 mm size in the cerebello-pontine-angle and hearing within 20 dB pure tone average/80% speech discrimination score had a success rate of 76%. Patients with hearing between the 20 dB pure tone average/80% speech discrimination score and 30 dB pure tone average/ 70% speech discrimination score had a success rate of 41%, which increased to 53% if the limit to success was set at 40 dB pure tone average/60% speech discrimination score. Patients with a tumour larger than 10 mm or hearing worse than 30 dB pure tone average/70% speech discrimination score had a poor preservation rate. In conclusion, hearing preservation surgery on a ≤ 10 mm acoustic neuroma with good hearing had a high rate of success and appeared to be a realistic treatment option which could be integrated with observation and radiotherapy in updated guidelines of treatment.

Before M.A.S.T.-I: analysis of the population of a participating center.

Between 1 January 1989 and 31 December 1990 568 consecutive patients were admitted to our unit for ischemic stroke (defined on clinical criteria and with CT or MR evidence of ischemic areas or exclusion of hemorrhage or tumor). The interval between onset of symptoms and arrival in hospital was under 6 h in 270 cases (47.5%). We classified our population according to the clinical criteria proposed by Bamford et al. by subgroup as follows: LACI (27.5%); PACI (24.5%); TACI (30.6%); POCI (17.4%). The mortality in our population was 10.9%. The distribution of the risk factors considered was: hypertension in 387 cases (67%), diabetes in 158 cases (27.8%), NVAF in 95 cases (16.7%). Our data show that about a half of all patients with ischemic stroke can expect to receive treatment at the acute stage.

Brachial plexus injuries. Guidelines for management: our experience.

In spite of the progress made by microneurosurgery, the treatment of brachial plexus injuries still remains a great challenge. This personal series of 49 patients with brachial plexus injuries (excluding tumours and thoracic outlet syndromes) is peculiar because the cases arose after the introduction in Italy of the law requiring all motorcyclists to wear a safety helmet. Our experience confirms that there has been a 32% increase in very severe almost irreparable injuries of the plexus in comparison with previous data reported in the literature. This is probably due to the higher rate of survival among severely-injured patients, although the possibility of a direct effect of the helmet on the plexus cannot be completely discarded. Our results confirm the good prognosis of the microsurgical repair of C5-C6 stretch injuries and infraclavicular lesions.