Juhani Partanen

Effects of Acute Alcohol Ingestion on Heart Rate Variability in Patients With Documented Coronary Artery Disease and Stable Angina Pectoris

The effects of acute alcohol intake (ethanol blood concentration 1.3 +/- 0.4%) on heart rate variability were evaluated with 24-hour Holter recordings in 20 patients with stable coronary artery disease in a juice-controlled experiment. In the frequency domain analysis, the high-, low-, and very low frequency components were significantly decreased after alcohol: these changes last longer than the elimination of alcohol.

Acute Renal Failure Caused by Alcohol-Induced Rhabdomyolysis

5 cases of severe acute renal failure caused by ethyl alcohol-induced rhabdomyolysis are reviewed. 4 patients were dialyzed. All patients recovered completely from the renal failure.

Acute Renal Failure Following Nontraumatic Rhabdomyolysis

The etiology and clinical course of acute nontraumatic rhabdomyolysis and ensuing renal failure was surveyed in a series of 40 consecutive patients. In 28 cases the muscle damage occurred after excessive consumption of ethyl alcohol and/or other intoxications. Prolonged lying immobilized was the reason or contributing factor for rhabdomyolysis in 22 cases. The other evident etiologies were convulsions, vigorous physical exercise, arterial occlusion and hypothermia. Typical local signs of rhabdomyolysis--pain, swelling and weakness of the affected muscles--were absent in one fourth of the patients. In these cases the diagnosis was based on transient elevation of serum creatine kinase enzyme activity. Dialyses were required to manage acute renal failure in 24 subjects. All 36 survivors recovered normal renal function. Neurological defects in the extremities still persisted in 16 patients at three months follow-up.

The effect of interruption to propofol sedation on auditory event-related potentials and electroencephalogram in intensive care patients

IntroductionIn this observational pilot study we evaluated the electroencephalogram (EEG) and auditory event-related potentials (ERPs) before and after discontinuation of propofol sedation in neurologically intact intensive care patients.MethodsNineteen intensive care unit patients received a propofol infusion in accordance with a sedation protocol. The EEG signal and the ERPs were measured at the frontal region (Fz) and central region (Cz), both during propofol sedation and after cessation of infusion when the sedative effects had subsided. The EEG signal was subjected to power spectral estimation, and the total root mean squared power and spectral edge frequency 95% were computed. For ERPs, we used an oddball paradigm to obtain the N100 and the mismatch negativity components.ResultsDespite considerable individual variability, the root mean squared power at Cz and Fz (P = 0.004 and P = 0.005, respectively) and the amplitude of the N100 component in response to the standard stimulus at Fz (P = 0.022) increased significantly after interruption to sedation. The amplitude of the N100 component (at Cz and Fz) was the only parameter that differed between sedation levels during propofol sedation (deep versus moderate versus light sedation: P = 0.016 and P = 0.008 for Cz and Fz, respectively). None of the computed parameters correlated with duration of propofol infusion.ConclusionOur findings suggest that use of ERPs, especially the N100 potential, may help to differentiate between levels of sedation. Thus, they may represent a useful complement to clinical sedation scales in the monitoring of sedation status over time in a heterogeneous group of neurologically intact intensive care patients.

Nascent body ego: Metapsychological and neurophysiological aspects

For Freud, body ego was the organizing basis of the structural theory. He defi ned it as a psychic projection of the body surface. Isakowers and Lewins classical fi ndings suggest that the body surface experiences of nursing provide the infant with sensory‐affective stimulation that initiates a projection of sensory processes towards the psychic realm. During nursing, somato‐sensory, gustatory and olfactory modalities merge with a primitive somatic affect of satiation, whereas auditory modality is involved more indirectly and visual contact more gradually. Repeated regularly, such nascent experiences are likely to play a part in the organization of the primitive protosymbolic mental experience. In support of this hypothesis, the authors review fi ndings from a neurophysiological study of infants before, during and after nursing. Nursing is associated with a signifi cant amplitude change in the newborn electroencephalogram (EEG), which wanes before the age of 3 months, and is transformed at the age of 6 months into rhythmic 3‐5 Hz hedonic θ‐activity. Sucking requires active physiological work, which is shown in a regular rise in heart rate. The hypothesis of a sensory‐affective organization of the nascent body ego, enhanced by nursing and active sucking, seems concordant with neurophysiological phenomena related to nursing.

Profuse mediastinal haemorrhage due to mediastinitis after sternotomy. Report of three cases and review of the literature.

Profuse spontaneous haemorrhage occurred in association with mediastinitis after median sternotomy for coronary bypass surgery in three men aged 54, 47 and 59 years. The bleeding sites were aorta, right ventricle and saphenous bypass graft. The aortic rupture occurred during closed lavage, the right ventricle ruptured during open saline mediastinal packing and the saphenous vein graft was eroded by a mediastinal drainage tube after discontinuation of closed lavage. This third patient survived and recovered, but the two others died. Previously published reports of 56 patients with 65 bleedings from this rare complication are reviewed. The outcome was fatal in 34% of cases.

Needle-Electromyography Findings of Trigger Points in Neck-Shoulder Area Before and After Injection Treatment

Objectives: Evaluate the electromyographic findings in the trigger points [TrPs] of 31 patients, suffering from myofascial pain syndrome in the neck-shoulder area, before and after injection treatment. Methods: One hundred and seventy-two TrPs and 31 reference points were studied with needle-electromyography and then the TrPs were injected via the same needle with small doses of either botulinum toxin A [BTA] or saline in a double-blind study. Results: In the baseline, the occurrence of spontaneous electrical activity containing endplate spikes [EPS] was 23.3 percent in all the TrPs and 9.7 percent in the reference points. This difference did not reach statistical significance, but the difference was statistically significant in the TrPs of upper trapezius [P = 0.02 on the left and 0.04 on the right side]. We found complex repetitive discharges in 3.5 percent of studied TrPs, but not at any of the reference points. At four weeks after the BTA treatment, fibrillation potentials were found in 31.3 percent of the TrPs against none in the saline group [P < 0.001]. Injections of BTA reduced the mean prevalence of EPS in TrPs significantly [P < 0.05] when compared with saline injections. The change of EPS prevalence correlated with the subjective result of treatment assessed on verbal scale, but not with other pain measurements. Conclusions: In our clinical study the occurrence of spontaneous electrical activity containing spikes was not specific to TrPs, but more common in some TrPs of the neck-shoulder area than in the painless point in deltoid muscle. The change of EPS prevalence may be related to the treatment outcome of TrPs.

Truncated HSPB1 causes axonal neuropathy and impairs tolerance to unfolded protein stress.

Background HSPB1 belongs to the family of small heat shock proteins (sHSP) that have importance in protection against unfolded protein stress, in cancer cells for escaping drug toxicity stress and in neurons for suppression of protein aggregates. sHSPs have a conserved α-crystalline domain (ACD), flanked by variable N- and C-termini, whose functions are not fully understood. Dominant missense variants in HSPB1, locating mostly to the ACD, have been linked to inherited neuropathy. Methods Patients underwent detailed clinical and neurophysiologic characterization. Disease causing variants were identified by exome or gene panel sequencing. Primary patient fibroblasts were used to investigate the effects of the dominant defective HSPB1 proteins. Results Frameshift variant predicting ablation of the entire C-terminus p.(Met169Cfs2*) of HSPB1 and a missense variant p.(Arg127Leu) were identified in patients with dominantly inherited motor-predominant axonal Charcot–Marie–Tooth neuropathy. We show that the truncated protein is stable and binds wild type HSPB1. Both mutations impaired the heat stress tolerance of the fibroblasts. This effect was particularly pronounced for the cells with the truncating variant, independent of heat-induced nuclear translocation and induction of global transcriptional heat response. Furthermore, the truncated HSPB1 increased cellular sensitivity to protein misfolding. Conclusion Our results suggest that truncation of the non-conserved C-terminus impairs the function of HSPB1 in cellular stress response. General significance sHSPs have important roles in prevention of protein aggregates that induce toxicity. We showed that C-terminal part of HSPB1 is critical for tolerance of unfolded protein stress, and when lacking causes axonal neuropathy in patients.

P3 amplitude and time-on-task effects in distractible adolescents.

OBJECTIVEnThe aim of our study was to examine the role of brain activity related to stimulus evaluation processes in distractibility by analyzing the P3 event-related potential.nnnMETHODSnWe studied the P3 response to target stimuli at the beginning, in the middle, and at the end of a two-tone auditory oddball task in easily distractible (n = 16) and non-distractible (n = 16) adolescents.nnnRESULTSnEasily distractible adolescents showed enhanced frontal and reduced parietal P3 amplitude across the blocks relative to non-distractible adolescents. Also, the usual decline in P3 amplitude at the end of the task was significantly larger in distractible than in non-distractible adolescents.nnnCONCLUSIONSnThese results suggests that the P3 effects are not limited to the neuropsychiatric disorders, and that increased distractibility may be characterized by reduced amount of resources allocated to the task with continued testing.nnnSIGNIFICANCEnThe results of this study contribute to elucidation of the functional basis of distractibility.

Compound nerve conduction velocity- a reflection of proprioceptive afferents?

OBJECTIVEnTo gather the required sample size to compare compound nerve conduction velocities (CV) to cutaneous sensory CVs and motor CVs to find out if there are statistically significant differences between these nerve fibre populations.nnnMETHODSnWe report age, height, and temperature standardized CVs for cutaneous sensory, motor, and compound nerve fibres measured by electroneuromyography (ENMG) for 109 median nerves in 74 people from different age groups with no known neuropathy (age 50.4, median 49, range 21-87).nnnRESULTSnIn the region of the forearm, mean CVs were 63.6m/s (CI=62.6-64.7) for compound nerve fibres, 61.3m/s (CI=60.1-62.5) for cutaneous sensory fibres, and 56.3m/s (CI=55.1-57.6) for motor fibres (for all p<0.001). Age explained most of the variation of CVs (Pearsons coefficients -0.394, -0,538, and -0.443, respectively, for all p<or=0.002), but also height and temperature displayed minor explanatory effects in multivariate analysis.nnnCONCLUSIONSnIt appears that compound nerve CVs are faster than cutaneous sensory and motor CVs. Compound nerve CV may represent muscle spindle afferents.nnnSIGNIFICANCEnThese data contribute to an understanding of the neurophysiological mechanisms that are involved in normal function of the human peripheral nervous system.