W e carried out a prospective randomised study comparing medial epicondylectomy with anterior transposition for the treatment of ulnar neuropathy at the elbow. The mean follow-up period was 4.5 years and we assessed the patients neurologically and orthopaedically.Neither procedure appeared to have a significant effect on elbow function. Our study showed better results after medial epicondylectomy; in particular patient satisfaction was higher than after ulnar nerve transposition. There were no significant differences in motor power or nerve-conduction rates and sensory fibres appeared to be more vulnerable to devascularisation. [Br] 1996;78-B:777-9. Received 15 August 1995; Accepted after revision 6 February 1996 The place of surgery in the treatment of lesions of the ulnar nerve at the elbow is uncertain: a variety of procedures has been recommended. There have been several reports of good results for medial epicondylectomy (King and Morgan 1959;Craven and Green 1980;Froimson and Zahwari 1980;Robinson, Aghasi and Halperin 1992), but none of these includes comparison with other operations, such as the commonly performed anterior transposition of the nerve (Macnicol 1979;Adelaar, Foster and McDowell 1984;Lundborg 1992). J Bone Joint SurgWe have performed a prospective randomised study of medial epicondylectomy and anterior transposition for the treatment of lesions of the ulnar nerve at the elbow. PATIENTS AND METHODSFrom 1985 to 1992, a total of 52 patients had operations for ulnar neuropathy and were entered into the study. Nine were lost to follow-up of whom two had died, records were untraceable in four, and three had moved away and could not be contacted. This left 43 patients, four of whom had bilateral operations, giving 47 cases. The mean age at operation was 58 years (36 to 85). Seven patients had preexisting osteoarthritis of the elbow, but there was no apparent cause in 36. For entry into the study, patients had to fulfil the following criteria: 1) clinical evidence of a lesion of the ulnar nerve at the elbow; 2) demonstrable slowing of conduction of the ulnar nerve at the elbow; 3) persistent symptoms for at least three months; 4) no rheumatoid disease at the elbow; and 5) no valgus deformity, defined as a carrying angle of more than 5° greater than the opposite elbow.All patients had a detailed neurological assessment (DJ) and nerve-conduction studies (NJS) before operation and at 12 months. They were randomly allocated to one of the two operations by the use of sealed envelopes which were only opened in the operating theratre just before the procedure. All surgery was performed by one of two surgeons (NJB or CJH), so that both procedures were performed by both surgeons, thus avoiding any technical bias.Neurological assessments, made before operation and at follow-up, included muscle strength rated on a scale of 0 to 5, muscle atrophy and sensation evaluated by light touch and static two-point discrimination. Pain in the hand was scored from 5 for severe nocturnal pain to zero. Follow-up review w...

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We have studied 12 healthy full-term babies, mean age 3.2 days, using physiological criteria--EEG, electrooculogram, electromyogram, respiratory regularity and visible movement--to assess sleep state, and a respiratory jacket to record changes in functional residual capacity (FRC). A total of 593 min of sleep data were analysed. Of the recordings, 39% were scored as quiet sleep, 40% as active and 21% as indeterminate sleep. The mean maximum variation in FRC overall was 29 ml (SD +/- 15.4 ml). Examination of these figures showed that FRC variations during sleep state changes were smaller than those seen within a defined sleep state. We conclude that changes in sleep state are not associated with variations in FRC.

A family is described in which a mother and three of her five children showed myoclonic epilepsy. The mother and one son were also ataxic; one other son had additional features of Friedreich's ataxia, and a daughter had peroneal muscular atrophy as well as myoclonic epilepsy and ataxia. Although some of these disorders have been associated in previously reported families, the occurrence of all three disorders in members of one family seems to be unique. It is concluded that this family shows the manifestations of one, probably dominant, gene. The differences in age of onset and manifestations may be explained by the action of one or more subsidiary genes.

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The loss of somatosensory evoked potentials (SSEP's) was investigated in a feline model of intracranial hypertension. Threshold values of cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) required for maintenance of SSEP's are defined using a mathematical model. The model describes loss of amplitude of SSEP's using the form of a dose-response curve. Amplitude of the SSEP's declined to 50% of control values at a CBF of 15 ml/100 gm/min and a CPP of 20 mm Hg in the normoxic animal; in the presence of mild hypoxia (8 to 9 kPa), a significant increase in these values to 18 ml/100 gm/min and 32 mm Hg, respectively, occurred. No reliable changes in latency or central conduction time were demonstrated. It is concluded that given adequate oxygenation, evoked electrical activity is lost at too low a level of CPP for this parameter to be useful in clinical monitoring. However, even mild hypoxia, when combined with intracranial hypertension, produces a major risk to neuronal integrity.

The presence of an alpha pattern on electroencephalography is well described in patients with coma following trauma, hypoxia, metabolic dysfunction and cardiorespiratory arrest. This is generally regarded as an adverse prognostic factor especially the non-reactive complete form. We report a 15-year-old girl with complete alpha coma following head injury, who subsequently made a good physical recovery. We believe that this case should help pediatric neurologists, intensivists and neurophysiologists in the future, who have to make difficult management decisions and will inform their discussions with the child's parents or guardians.

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