Plasma exchange has been reported to be a successful therapeutic procedure for the treatment of severely compromised myasthenic patients, but the optimal regimen in terms of costs or clinical benefit has not so far been determined. We have investigated the efficacy of a short plasmapheresis protocol of two exchanges 1 day apart in a series of 70 patients with severe forms of myasthenia gravis. Patients were evaluated before and 7 days after the first exchange. A positive outcome was observed in 70% of the plasma exchange cycles performed. Disease severity did not seem to be a negative prognostic factor for the efficacy of this short protocol, which was well tolerated by patients. In only 1 case were major side-effects observed. In spite of its short duration, the exchange treatment plus concomitant immunosuppressive drug therapy was not followed by early clinical deterioration.

SummarySensitivity to the action of nondepolarising relaxants was compared in muscles of upper and lower limbs in four syringomyelic patients undergoing elective neurosurgical procedures. It was observed that muscles with signs of lower motor neurone dysfunction are supersensitive to the action of nondepolarising relaxants. Terminal sprouting of motor axons and the occurrence of newly formed neuromuscular junctions may be responsible for a low synaptic eficacy and may explain the high sensitivity to factors that reduce the safety margin of neuromuscular transmission. Key wordsNeuromuscular relaxants; syringomyelia.Syringomyelia is a pathological condition in which motor deficit of the upper limbs may be frequently caused by lower motor neurone dysfunction and lower limb deficit by a pyramidal lesion. Resistance of centrally denervated muscles to the action of nondepolarising relaxants is well d~curnented.'-~ However, little is known about the sensitivity of denervated muscles in patients with lower motor neurone dysfunction. ' Experimental evidence demonstrates that extrajunctional acetylcholine receptors appearing after denervation may have a poor affinity for tubocurarine,'Oxl' which, it has also been shown, may exert an agonist type of action on denervated muscles in some animals.I2 Clinical experience, on the other hand, indicates that sensitivity to curare might be greater than normal in patients with lower motor neurone dysfunction. Decremental responses and increased jitter, in fact, are common in electromyographic examinations of these We report clinical observations which indicate that denervated muscles of syringomyelic patients have an increased sensitivity to the action of nondepolarising relaxants. MethodsPatients were scheduled for elective neurosurgery. They were premedicated with diazepam and atropine. Anaesthesia was induced with fentanyl and thiopentone and maintained with either halothane or isoflurane, nitrous oxide and oxygen. Ventilation of the lungs was adjusted to produce a normal end-tidal carbon dioxide concentration, and the heart rate was recorded with an ECG monitor.Neuromuscular block produced by the intubating dose of nondepolarising relaxants was assessed by the use of a Datex Relaxograph and at various intervals, a Medelec 'MS 92a' unit was used to compare the extent of neuromuscular blockade in different muscles. Motor nerves were stimulated at 2 Hz with supramaximal stimuli given in trains-of-four or in trains-of-nine. The extent of block was assessed by the evaluation of fade. Fade was given by (1 -T4/T1) x 100; where T4 is the amplitude of the fourth response in a train and T1 is the amplitude of the first response.To increase the reliability of the procedure, studies that had been initiated with the Datex unit were completed with the Medelec and vice versa. The same surface electrodes were used in both examinations. Case historiesPatient 1, a 74 kg, 45-year-old woman was admitted to hospital with a history of many years of cervical pain and progressive weakness of the left...

Thirty-seven myasthenic patients were treated with therapeutic plasma exchange (TPE) on different performance schedules using either random or single donor plasma. The two schedules had the same effects in terms of efficacy but single donor replacement gave significantly less side effects in the short and long term. A two exchange procedure on alternate days associated with immunosuppression seems to be an optimal schedule for the treatment of myasthenic patients. A single donor two-exchange on alternate days procedure appears to be safe, useful and can be repeated in patients who need frequent TPE.

Penelitian ini bertujuan untuk mendeskripsikan peran guru dalam pembelajaran seni budaya melukis dengan menggunakan media di SDI Manunai Maumere. Penelitian ini menggunakan metode deskriptif melalui pendekatan kualitatif. Sumber data dalam penelitian ini adalah guru seni budaya dan siswa yang mengikuti pembelajran seni budaya di kelas IV SDI Manunai Maumere yang berjumlah 30 siswa. Teknik pada pengumpulan data dilakukan pada penelitian ini adalah observasi, wawancara, dokumentasi dan angket. Peran guru yang terdapat pada proses pembelajaran di SDI Manunai Maumere memperlihatkan sesungguhnya guru bias mengelementasikan 7 dari 9 peran guru yang dijalankan pada proses belajar mengajar, yaitu guru sebagai perencana proses belajar dan mengajar, guru sebgai pengatur proses belajar, guru sebagai pembimbing dalam proses belajar, guru sebagai penilai, guru sebagai tempat konsultasi kepada siswa, guru harus menggunakan kurikulum yang berbasis lingkungan, tugas serta tanggung jawab guru, dan syarat guru yang baik dan berhasil.