Prolonged myoclonus and meningism following propofol.

The purpose of this report is to describe a new complication of propofol administration. A previously fit patient underwent intravenous anaesthesia with propofol for removal of dental wires. Postoperatively he developed myoclonic jerking of his limbs. On regaining consciousness he complained of an occipital headache, neck stiffness and photophobia, and was found to have nuchal rigidity on examination. These clinical features resolved over the following week. Subsequent investigations failed to explain the aetiology of the symptoms of meningeal irritation, which suggests that propofol was the causative agent. While prolonged myoclonus has been previously described with propofol administration, this is the first report of meningism occurring with its use.

Clinical implications of acute cerebrospinal fluid changes following iophendylate myelography.

Clinical features and serial cerebrospinal fluid (CSF) samples of 50 patients who underwent myelography with iophendylate were studied. Forty two patients (84%) developed one or more features suggestive of meningism lasting for 2-4 days. There was significant rise in the average (mean) CSF counts from 9.81 in the premyelogram sample to 532.6 at the end of 24 hours (p less than 0.001). Both neutrophil and lymphocyte (p less than 000) count increased. At the end of one week, there was significant decrease of total cells in the CSF to 204 (p less than 0.001). Both, neutrophils and lymphocytes decreased. There was significant rise in total proteins in the 24 hours sample, but the fall at one week was not significant statistically. The sugar and chloride values did not change significantly. All CSF samples were negative for bacterial cultures. In conclusion, a significant proportion of the patients undergoing iophendylate myelography develop clinical features suggestive of meningeal irritation and change in the CSF fractions suggestive of meningitis: however these changes are transient and do not warrant institution of chemotherapy or steroids.

Chemical meningism after lumbar facet joint block with local anaesthetic and steroids.

A case is reported in which chemical meningism occurred after lumbar facet joint block with methylprednisolone acetate and bupivacaine. This complication was probably due to inadvertent dural puncture. The use of steroids in facet joint injections is questioned.

Post-myelographic meningeal irritation with iohexol.

A 45-year-old woman developed signs of meningeal irritation after myelography with iohexol. Her condition improved very quickly (after antibiotic treatment). Rapid improvement, absence of pathogenic organisms in the pre-treatment CSF culture, the level of CSF pleocytosis and protein were in favor of chemical meningitis.

Failure of intravenous and intrathecal cytarabine to modify central nervous system IgG synthesis in multiple sclerosis.

To study the nature of the multiple sclerosis (MS) central nervous system (CNS) immune reaction, cytarabine (ara-C) was administered intravenously to three patients and intrathecally to another seven. Although intravenous administration severely suppressed circulating leukocytes derived fom the bone marrow, there was no change in de novo CNS IgG synthesis (rate or presence of CSF IgG oligoclones). Therefore, the MS CNS immune reaction can persist in the presence of severe granulocytopenia and severe monocytopenia of one to two weeks' duration. In four patients who were given ara-C intrathecally, cytotoxic levels (> 10 micrograms/ml) were present for a least 24 hours. A brief elevation in CSF albumin indicated transient damage to the blood-brain barrier. Leukopenia did not result in the seven patients treated intrathecally, and de novo CNS IgG synthesis did not change or was transiently increased. Assuming that cytotoxic levels in CSF diffused to the CNS sites responsible for synthesizing IgG, results indicate that CNS IgG synthesis does not depend on in situ rapid turnover of immune cells. None of the ten patients demonstrated neurological improvement or persistent adverse effects.

[Diagnosis and therapy of acute leukemia in adults]. / Diagnostik und Therapie bei akuten Leukämien Erwachsener.

Apart from the most essential aspects of the diagnosis and differential diagnosis of acute leukaemias concerning the early diagnosis of leukaemias the author deals with the so-called praeleukaemia. On the basis of a survey of international literature the modern polychemotherapy and its successes are characterized as well as the necessary supportive haemotherapy) are dealt with. Despite the improved frequency of remissions the survival time of acute leukaemias could only little be prolonged, that of the first remission could not be prolonged. Perhaps it is possible by an in future improved immunotherapy and by allogenic transplantation of the bone-marrow after supralethal total body irradiation to set new measures in the treatment of acute leukaemias.

Reactions to iophendylate in relation to multiple sclerosis.

A retrospective survey was made of 57 consecutive patients referred for myelography by one neurological team. Reactions occurred in patients with multiple sclerosis significantly more often than in all other patients (P=0.01). This finding appears to support the belief that demyelination may be associated with more severe reactions to iophendylate myelography.