An unruptured tubal pregnancy at term.

We report a case of advanced, unruptured tubal pregnancy proceeding beyond term. A 25-year-old woman was admitted at 42 weeks' gestation because of lower abdominal pain and inability to feel fetal movements. An ultrasound examination suggested fetal death. At laparotomy three weeks after admission, a right-sided, unruptured tubal mass containing a macerated fetus was found.

Percutaneous magnetic coil stimulation of human cervical vertebral column: site of stimulation and clinical application.

In order to understand which neural elements are excited after percutaneous magnetic coil (MC) stimulation over the cervical vertebral column we have performed such study in 8 normal subjects and 4 patients. On moving the coil rostrocaudally up to 3 cm and horizontally up to 2 cm from the midline we found no change in the latencies of the compound muscle action potentials to biceps, deltoid, abductor pollicis brevis (APB) and abductor digiti minimi muscles indicating a fixed site of excitation of the spinal roots within the intervertebral foramina. F latencies to APB after stimulation of the median nerve at the wrist were always longer than the direct latencies obtained after cervical vertebral stimulation. The mean difference between indirect latency based on F technique and direct latency to APB was 0.45 msec which represented a distance of 2.7 cm distal to the anterior horn cells assuming a conduction velocity of 60 m/sec. MC stimulation in 2 patients suggested a diagnosis of cervical radiculopathy which was confirmed by imaging studies or operative findings. Both MC and needle root stimulation in one patient with diabetic brachial plexopathy and in another with diabetic polyneuropathy suggested that the needle stimulation occurred about 1.2-1.8 cm proximal to MC stimulation.

Effect of prednisolone on motor end-plate fine structure: a morphometric study in hamsters.

The fine structure of quadriceps motor end-plates in hamsters was analyzed quantitatively one, two, four, seven, and thirty-two weeks following intraperitoneal injections of prednisolone. Except for transient increases in postsynaptic length and membrane profile concentration after prednisolone administration at dosages of 4 mgper kilogram of body weight for one week and 2 mg per kilogram for four weeks, mean values for various measurable profiles in the presynaptic and postsynaptic regions showed no significant differences between control and treated animals.

Effect of adrenocorticotrophic hormone on muscle acetylcholinesterase and nonspecific esterase.

Acetylcholinesterases in the muscle homogenates of hamsters receiving ACTH intraperitoneally for six weeks were reduced as compared to the activities in the control samples. In polyacrylamide disc gel electrophoresis of the ACTH-treated muscles some acetylcholinesterase bands were absent. These observations may be significant in explaining the ACTH-induced improvement in myasthenia gravis patients and in the pathophysiology of steroid myopathy.

Percutaneous magnetic coil stimulation of the phrenic nerve roots and trunk.

We describe a technique of percutaneous magnetic coil (MC) stimulation of the phrenic nerve trunk on one side of the neck and phrenic roots over the upper cervical vertebral column in 10 normal subjects and 2 patients. We were able to obtain compound muscle action potentials (CMAPs) from the diaphragm at two sites (xiphoid process and 7th intercostal space) after stimulation of the phrenic nerve trunk and roots. We noted that the onset latencies after phrenic root stimulation remained fixed despite increasing the stimulus intensity from 50% to 100% and on moving the MC vertically or laterally, suggesting that stimulation of the fastest conducting fibers was occurring at a fixed site, most likely at the intervertebral foramina. Absent responses unilaterally in one and prolonged latencies to diaphragmatic CMAPs in another patient confirmed phrenic neuropathy in these patients.

Magnetic coil stimulation of the human lumbosacral vertebral column: site of stimulation and clinical application.

We describe the technique of magnetic coil (MC) stimulation of the lumbosacral roots and the possible site of stimulation in 22 control subjects, and the clinical usefulness of MC stimulation in 5 patients with low back pain. We observed 2 components in the compound muscle action potential of the soleus muscle following MC stimulation over the lumbosacral region. The second component had the physiological properties of the H reflex. The conduction time from the anterior horn cells of the lumbosacral spinal cord to the site of nerve root stimulation over the lumbosacral vertebral column was indirectly calculated as between 3.9 and 4.1 msec. Assuming a conduction velocity of 50 m/sec this would represent a distance of approximately 20 cm from the spinal motor neurons. Based on our control and patient data we conclude that the MC stimulation may be an useful technique for the diagnosis of lumbosacral radiculoplexopathy.