Diagnosis of small fiber neuropathy: A comparative study of five neurophysiological tests.

The diagnosis of small fiber neuropathy (SFN) is a challenge for clinical neurophysiology. Conventional nerve conduction studies are inappropriate for this purpose and therefore various neurophysiological tests have been proposed. In this study, we compared the diagnostic value of five of these tests in 87 patients with clinically definite (n=33) or possible (n=54) SFN related to amyloid neuropathy secondary to transthyretin gene mutation or monoclonal gammopathy (n=30), primary Sjögren's syndrome (n=20), Fabry's disease (n=2), or unknown cause (n=35). Neurophysiological tests included quantitative sensory testing with determination of warm and cold detection thresholds (WDT, CDT), recording of laser-evoked potentials (LEP) and sympathetic skin responses (SSRs), and measurement of electrochemical skin conductance (ESC) using Sudoscan(®) device. All tests were performed at the four extremities (hands and feet). All patients with clinically definite SFN and 70% of the patients with possible SFN had at least one abnormal test. The LEP was the most sensitive test (altered in 79% of the patients with at least one abnormal test), followed by ESC (61%), WDT (55%), SSR (41%), and CDT (32%). The combination of LEP, assessing A-delta sensory fibers, WDT, assessing sensory C fibers, and ESC, assessing autonomic C fibers, appears a relevant approach for the diagnosis of SFN. Compared to SSR and CDT, these three tests, LEP, WDT, and ESC, had a significantly better diagnostic sensitivity and their combination further improved diagnostic accuracy.

Pain-related evoked potentials: a comparative study between electrical stimulation using a concentric planar electrode and laser stimulation using a CO2 laser.

OBJECTIVE: To compare the pain-related evoked potentials (PREPs) obtained by superficial electrical stimulation using a concentric planar electrode to those obtained by CO2 laser stimulation. METHODS: In 12 healthy subjects, PREPs, sympathetic skin reflexes (SSRs), motor reaction times (mRTs), and the conduction velocity (CV) of the recruited nerve fibres were assessed in response to electrical and laser stimulation. RESULTS: In response to superficial electrical stimulation, PREP latencies and mRTs were shorter, while PREP amplitude tended to be increased. By contrast, SSR amplitudes and latencies and estimated CVs of the stimulated nerve fibres did not differ between electrical and laser stimulation. Fifteen minutes after PREP recordings, the residual pain intensity and the degree of unpleasantness were higher for laser stimulation than for electrical stimulation. In addition, CO2 laser stimuli induced dyschromic spots on the skin. For these reasons, all subjects declared that they would prefer superficial electrical stimulation rather than CO2 laser stimulation if they had to perform PREPs again. CONCLUSIONS: The estimated CVs of the recruited nerve fibres and the localized pinprick sensation felt by the subjects suggest that small-diameter fibres in the A-delta range, conveying "first-pain" information, were stimulated in response to superficial electrical stimulation as for laser stimulation. Superficial electrical stimulation using a concentric planar electrode could be a valuable alternative to laser stimulation for assessing PREPs in the practice of clinical neurophysiology.

Monoclonal antibody-mediated clean-up procedure for the high-performance liquid chromatographic analysis of chloramphenicol in milk and eggs.

A simple, rapid and specific sample preparation method based on antibody-mediated clean-up for the determination of chloramphenicol (CAP) in milk and eggs was developed. Skimmed milk and centrifuged egg homogenates were filtered and directly applied to immunoaffinity columns which were prepared by coupling monoclonal antibodies against CAP to a carbonyldiimidazole-activated support. Using a 0.2 M glycine, 0.5 M NaCl (pH 2.8) solution as an eluent, the immunoaffinity columns can be used more than 30 times without a decrease in column capacity. In subsequent high-performance liquid chromatographic analysis, no matrix interferences were observed. Good recoveries were obtained at spiking levels of 1-100 micrograms kg-1. Due to the high specificity of the clean-up procedure, the limit of detection can be lowered by increasing the test portion. Concerning milk, the limit of detection was successfully lowered to 20 ng kg-1 by increasing the test portion to 11 (recovery 99%). The method was applied to eggs produced by hens treated with CAP. The results are compared with those obtained by solid-phase extraction using silica gel.