Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc.

STUDY AIM: This prospective study aim to examine whether clinical findings and electrodiagnostic testing (EDX) in patients with lumbosacral monoradiculopathy due to herniated disc (HD) differ as a function of root involvement level (L5 vs. S1) and HD zone (paramedian vs. intraforaminal). PATIENTS AND METHODS: All patients with L4, L5 or S1 monoradiculopathy were prospectively enrolled at four electromyography (EMG) labs over a 2-year period. The diagnosis was based on a congruence between patient history and MRI evidence of HD. We compared the sensitivities of clinical findings and EDX with respect to both root involvement level and HD zone. Multivariate logistic regression was performed in order to verify the association between abnormal EMG, clinical, and neuroradiological findings. RESULTS: One hundred and eight patients (mean age 47.7 years, 55% men) were consecutively enrolled. Sensory loss in the painful dermatome was the most frequent finding at physical examination (56% of cases). EMG was abnormal in at least one muscle supplied by femoral and sciatic nerves in 45 cases (42%). Inclusion of paraspinal muscles increased sensitivity to only 49% and that of proximal muscles was useless. Motor and sensory neurography was seldom abnormal. The most frequent motor neurographic abnormalities were a delay of F-wave minimum latency and decrease in the compound muscle action potential amplitude from extensor digitorum brevis and abductor hallucis in L5 and S1 radiculopathies, respectively. Sensory neurography was usually normal, the amplitude of sensory nerve action potential was seldom reduced when HD injured dorsal root ganglion or postganglionic root fibres. Multivariate logistic regression analysis showed that EMG abnormalities could be predicted by myotomal muscular weakness, abnormal deep reflexes, and paraesthesiae. The only clinical and electrophysiological differences with respect to root involvement level concerned deep reflexes and motor neurography of deep peroneal and tibial nerves. CONCLUSIONS: Only some EDX parameters are helpful for the diagnosis of lumbosacral radiculopathy. EMG was abnormal in less than 50% of cases and its abnormalities could be predicted by some clinical findings. However, neurography is useful as a tool for differential diagnosis between radiculopathy and more diffuse disorders of the peripheral nervous system (polyneuropathy, plexopathy)

\u2018Mind the Gap: IR and the challenge of international politics'

The discipline of International Relations (IR) for a long time of its history has developed in the form of Great Debates that involved competing paradigms and schools. More recently, it has been described as a cacophony of voices unable to communicate among themselves, but also incapable to provide keys to understand an ever more complex reality. This collection aims at evaluating the heuristic value of a selection of traditional paradigms (realism and liberalism), schools (constructivism), and subdisciplines (security studies and international political economy) so as to assess the challenges before IR theory today and the ability of the discipline to provide tools to make the changed world still intelligible

Sensory nerve action potential amplitude is rarely reduced in lumbosacral radiculopathy due to herniated disc.

OBJECTIVE: Normal sensory nerve action potential (SNAP) amplitude is a classical neurographic rule whether damage is located proximal to the dorsal root ganglion (DRG) as in radiculopathy. The study's aim is to check SNAP reduction in patients with lumbosacral radiculopathy due to herniated disc (HD). METHODS: A total of 108 consecutive patients with lumbosacral monoradiculopathy were prospectively enrolled. The diagnosis was based on clinical findings and magnetic resonance imaging (MRI). Electromyography of muscles of L4-S1 myotomes, motor neurography of peroneal and tibial nerves and sensory neurography of saphenous, superficial peroneal and sural nerves were performed. Percentage decrease in SNAP amplitude of nerves between healthy and affected sides was calculated. RESULTS: Significant SNAP amplitude asymmetry was observed in superficial peroneal nerve in seven patients with L5 (12.1%) and in sural nerve in one patient with S1 (2.4%) radiculopathies. All these patients had foraminal HD. CONCLUSIONS: SNAP amplitude reduction of sensory nerve originating from damaged root is present only in 7% of radiculopathies and is likely due to DRG compression when located proximal to the spinal foramen or within the intraspinal canal. SIGNIFICANCE: Preservation of SNAP amplitude in radiculopathy remains an electrophysiological dogma with a little exception. If the reduction of SNAP amplitude affects other nerves, causes other than radiculopathy should be sought

Clinical Features and Outcome of the Guillain–Barre Syndrome: A Single-Center 11-Year Experience

Background: Clinical presentation, electrophysiological subtype, and outcome of the Guillain-Barre' Syndrome (GBS) may differ between patients from different geographical regions. This study aims to assess clinical-neurophysiological features of an adult, Italian GBS cohort over 11 years. Methods: Retrospective (from 1 January 2011 to 31 December 2021) analysis was carried out on patients admitted to the Siena University Hospital who fulfilled the GBS diagnostic criteria. Demographic data, clinical characteristics, treatment, need of mechanical ventilation (MV), laboratory and electrophysiological tests, preceding infections/vaccination/other conditions, and comorbidities were collected for each patient. Results: A total of 84 patients (51 men, median age of 61 years), were identified. GBS subtype was classified as acute inflammatory demyelinating polyneuropathy (AIDP) in the 66.6% of patients, acute motor/sensory axonal neuropathy (AMAN/AMSAN) in 20.2%, and the Miller Fisher syndrome in 5 (5.9%). Flu syndrome and gastrointestinal infection were the most common preceding conditions. In total, five (5.9%) subjects had concomitant cytomegalovirus (CMV) infection. Cranial nerve involvement occurred in 34.5% of subjects. Differences between the axonal and AIDP forms of GBS concerned the presence of anti-ganglioside antibodies. In total, seven (8.33%) patients required MV. Discussion: The epidemiological and clinical characteristics of GBS in different countries are constantly evolving, especially in relation to environmental changes. This study provides updated clinical-epidemiological information in an Italian cohort

Rapporto tecnico sulle attività di campagna oceanografica “BANSIC 2013”

La campagna oceanografica BANSIC 2013 è stata condotta a bordo della N/O “Urania” dal 26 Giugno al 16 Luglio 2013 nell’ambito delle attività previste dal WP3 del progetto SSD-Pesca, finanziato dal MIUR su fondi MISE, a supporto della pesca italiana nelle Regioni Obiettivo 1, e dal progetto bandiera RITMARE (SP2_WP1_AZ1_UO01 e UO04) Obiettivi generali della campagna oceanografica sono stati lo studio delle relazioni tra le strutture oceanografiche a mesoscala (vortici verticali ed orizzontali, upwelling, ecc.) e le strutture spaziali dei fenomeni biologici relativi ai primi anelli della catena trofica (zooplancton, distribuzione e abbondanza di larve di piccoli pelagici e grandi pelagici), e lo sviluppo del dispositivo di Fishing Vessel Monitoring System denominato FOOS (Fishery Oceanography Observing System) da installare a bordo di imbarcazioni da pesca. In particolare, il campionamento di uova di acciuga è finalizzato all’applicazione del metodo DEPM (Daily Egg Production Method) per la stima dell’abbondanza dello stock riproduttore (SP2_WP1_AZ3_UO04). Il campionamento ittioplanctonico, che ha riguardato anche le acque Maltesi, è inserito anche nel piano di lavoro del progetto regionale MIPAF-FAO “MedSudMed” (“Assessment and Monitoring of the Fishery Resources and the Ecosystems in the Straits of Sicily”). La campagna ha visto anche l’avvio di una linea di ricerca in collaborazione con la Martin-Luther-Universität Halle-Wittenberg, avente come obiettivo i radiolari