[Exposure to glues containing technical heptane: a clinical and electrophysiological study]. / Esposizione a collanti contenenti eptano tecnico: studio clinico ed elettroneurofisiologico.

Polyneuropathy caused by n-hexane contained in glues was, until recently, the typical occupational disease of shoemakers. Glues no longer contain large concentrations of this solvent, and in some cases, it as been completely replaced by other hydrocarbons. The authors investigated the health status in a group of shoemakers using glues containing 35% technical heptane. The same glue, not containing n-hexane, was used by a shoemaker who worked at home; she developed an otherwise unexplainable peripheral polyneuropathy. For each of the 16 subjects, the following procedures were carried out: environmental sampling, biological monitoring for Mek and heptane metabolites, a neurological and electromyographic examination. No neurological abnormalities were found in the workers that could be attributable to occupational exposure, probably due to the low level environmental contamination (< 100 mg/m3 n-heptane) found in the 7 factories and workshops studied where acceptable hygiene conditions existed. The time course and ratio of urinary metabolites of heptane were also studied, the latter showing a predominance of 2- and 3- heptanol in the initial phase and 2-5 heptandione at the end of the work week; probably, the presence of other solvents, such as Mek, can modify the ratio of metabolites and consequently the formation of neurotoxic compounds could result.

Interhemispheric transfer in children with early-treated phenylketonuria.

Phenylketonuria (PKU) is a genetic disorder of amino acid metabolism that is associated with brain catecholamine depletion and deficient myelination. Although neuropsychological deficits have been documented in children with early-treated PKU (ETPKU), no study to date has examined possible effects of impaired myelination in this population. In the present study, interhemispheric transfer time was assessed for 14 children with ETPKU, 22 children with attention deficit-hyperactivity disorder, and 48 normal children, using a manual reaction time paradigm previously validated with callosal agenesis patients (Milner, 1982). Children with ETPKU demonstrated slowed interhemispheric transfer from the left to the right hemisphere as compared with the two other groups. The magnitude of slowing was correlated with age and phenylalanine levels at birth. Results support the hypothesis that abnormal myelination disrupts the development of interhemispheric connections in ETPKU, and suggest that left hemisphere projections may be particularly susceptible to such disruption.

[Ulnar neuropathy at the elbow in workers using column sewing machines: case reports and follow-up]. / Neuropatia del nervo ulnare a livello del gomito in addette all'uso di macchine per cucire a colonna: casistica e follow-up.

Fifteen cases of ulnar nerve neuropathy at cubital tunnel level were observed in women aged between 16 and 37 years employed in shoe factories. The women operated column sewing machines resting their elbows on the work table. Past evidence showed that the interval between the beginning of work and onset of neuropathy was generally more than one year but less than that for similar diseases observed in other jobs where arthritis of the elbow played a more important role and the average age was higher. It can therefore be supposed that arthritis in these shoes workers was of less significance, whereas local trauma, which was not prevented by the use of small soft cushions under the elbows (4 out of the 15 subjects had been using them for some time), seemed of greater importance. A period of less than one year (in one case only a few days) was deemed due to the presence of a pre-existing neuropathy of the elbow which had so far been asymptomatic. Cases treated within six months of onset showed marked improvement. However, rapidly worsening symptoms, independent of the degree of damage reached, often led to early treatment with favourable outcome in a short time, while slow and insidious onset brought a longer prognosis. The primary prevention suggested is to instruct workers as to the correct work posture, i.e., avoiding resting the elbows on the work table. As a secondary preventive measure, bearing in mind the need of early diagnosis and treatment, medical check-ups every six months are proposed.

Posterior interosseous nerve neuropathy. Clinical and electromyographical aspects.

A clinical-EMGraphic examination was carried out in 37 patients with posterior interosseous nerve neuropathy: 5 cases had a traumatic origin, 4 iatrogenic, and 28 non-traumatic. One of the non-traumatic cases had a lipoma, and another had chondroma. In the other cases, nerve entrapment at the level of the arcade of Frohse could be presumed. Acute or chronic onset of the deficit was probably due to repeated pronation-supination hand movements. A motor deficit in finger extension together with a radial deviation of the wrist, was typical. Surprisingly about 50% of the non-traumatic cases showed some sensory disturbance at the forearm, wrist or hand. EMG examination was useful to establish the entity and topography of the deficit. Follow-up was carried out in 27 cases (3 traumatic, 2 iatrogenic and 22 non-traumatic). Even if spontaneous recovery is possible, though infrequent, in non-traumatic cases with marked deficit surgery gave the most satisfactory results, especially when onset had been acute and operation was performed within nine months of onset.

Hyperbaric oxygen therapy in the treatment of multiple sclerosis. A clinical and electrophysiological study in a 2 year follow-up.

15 patients with chronic progressive Multiple Sclerosis were treated with Hyperbaric Oxygen Therapy at 2.0 atmospheres absolute for a total of 20 daily exposures followed by 2 exposures every month. The treatment was carried out for a 24 months follow-up. No objective benefit resulted from Hyperbaric Oxygen Therapy at the completion of the study while a subjective improvement in bladder control was reported in the short and in the long-term follow-up by 8 and by 5 patients respectively. No significant variations in the electrophysiological results were observed after the first 20 consecutive exposures. It is concluded from this trial that a long-term Hyperbaric Oxygen Treatment cannot moderate the progression of Multiple Sclerosis. However, an improvement in the quality of life can be obtained in some patients resulting from a better control of bladder function.

Pineal germinoma: diagnosis, treatment and tumor response.

We report the case of pineal germinoma in a 25 year old man. The neurological signs and symptoms were insidious in onset; Parinaud syndrome allowed a topical diagnosis, confirmed by CT scan. Computerized Tomography and CSF cytological examination were of the utmost importance to diagnosis and treatment and it confirmed the success of radiotherapy.

Effect of lymphocytapheresis plus cyclophosphamide on the course of a chronic progressive form of multiple sclerosis.

We report a case of a 16 year old boy with a chronic progressive form of Multiple Sclerosis treated with lymphocytapheresis and a low dose regimen of cyclophosphamide. A progressive improvement in the disability index and slowing of the clinical course were obtained. No side effects were observed. Depletion of lymphocytes and their pharmacological suppression point to their possible role in the induction of an immunoregulation of the disease process.