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Various infections can frequently lead to the exacerbation of myasthenia gravis (MG). COVID- 19 infection characterized by lung impairment with respiration failure, massive inflammatory reaction and high mortality may lead to worsening of many neuromuscular disorders including MG. Published series of patients with MG and COVID-19 are considerably variable and diff er in disease severity and selected therapeutic approach. In our group of 11 MG patients, substantial worsening was present in 3 patients, and in 4 there was a mild worsening of clinical myasthenic symptoms. In 3 patients, we used high doses of methylprednisolone intravenously, in 2 patients, the oral doses of prednisone were increased to 40 mg/ 60 mg a day, 1 patient was treated with intravenous immunoglobulin (2 g/ kg), and 1 was treated with remdesivir. An 88-year-old woman was diagnosed with MG after COVID-19 infection. A 77-year-old man died after 6 days of mechanical ventilation. COVID-19 infection leads to an exacerbation of clinical symptoms in a large proportion of MG patients with ventilation disorder due to increased muscle fatigue and inflammatory changes in the lung parenchyma. [ABSTRACT FROM AUTHOR]

Some lesions of the peripheral nerves caused by physical factors can, under certain conditions, be acknowledged as an occupational dis-ease. The decision whether it is an occupational dis-ease or not is authorized by the "Centre of occupational dis-eases". Neurological consultants have a very important role in the process of acknowledgement of an occupational dis-ease. Dur--ing the last 20 years, disorders of neurological character represented 29.6% of all occupational dis-eases. At the same time, the lesions of the peripheral nerves due to overload or vibration constituted 98.5%. Carpal tun-nel syndrome is most frequent, fol-lowed less often by an ulnar nerve lesion in the elbow, and rarely by an ulnar nerve lesion in the wrist and hand –  the Guyon's chan-nel. In the development of occupational compres-sive neuropathies, various mechanisms take place: mechanical pres-sure, hand overload, transmis-sion of vibration on the upper extremity, cold, inappropriate position dur--ing work, and other factors. For acknowledgement of occupational origin of such a lesion, it is es-sential to determine clinical signs and symp-toms, and EMG examination cor-respond--ing to at least the moderately severe lesion. Anamnestic, clinical, and EMG characteristics includ--ing electrophysiological parameters of a moderately severe lesion for the median and ulnar nerves were defined. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manu-script met the ICMJE "uniform requirements" for biomedical papers. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posterior muscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longus tendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. [ABSTRACT FROM AUTHOR]

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Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic infl am matory demyelinating polyradiculoneuropathy (CIDP) is a chronic demyelinat ing polyneuropathy with a relaps ing or progres sive course. This is a dysim mune polyneuropathy with activation of humoral and cel lular mechanisms with a primary lesion of myelin sheath in the peripheral nerves. Most frequent is a typical sym metrical polyneuropathy, multifocal neuropathy with a conduction block is less frequent, then distal sym metrical motor and sensory neuropathy, pure sensory or pure motor neuropathies occur rarely. Development of signs and symp toms beyond 2 months is a com mon feature for all variants. Dia gnosis of CIDP is based on clinical fi ndings, precisely developed electrophysiological criteria, and some laboratory fi ndings - hyperproteinor rhachia with normal cell count, and MRI with thicken ing and enhancement of nerves in brachalis and lumbar plexuses or roots. Corticosteroids or intravenous im munoglobulins are used as induction ther apy as the fi rst-line treatment of CIDP. Therapeutic plasma exchange is a second-line ther apy in patients with ineffi cacy or intolerability of the fi rst-line treatment. As adjuvant ther apy, they use azathioprin, mycofenolate mofetil, ciclosporin A, cyclophosphamide, and methotrexate. CIDP is a treatable neuropathy though in some patients it leads to invalidity. [ABSTRACT FROM AUTHOR]

Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ulnar nerve, together with median nerve, innervates the volar group of forearm muscles, hand and fingers. Ulnar nerve is more important for innervation of muscles and weakness, clumsiness of fingers and hand occure in case of the nerve lesion; ulnar claw hand developes in advanced cases. According to the length of the nerve and to the exposed course in regions of elbow and hand, the nerve is frequently overstretched and damaged. The nerve traumatization occurs only rarely in the axilla and arm regions. The ulnar nerve is very often damaged in the elbow, where the nerve is located in a differently deep ulnar nerve grove and then in the cubital tunnel. The ulnar nerve is protected in the forearm course by a layer of fl exor muscles. The nerve appears more superfi cially at the wrist and in the palm, where the ulnar nerve is exposed to chronic traumatization. An ulnar nerve lesion manifests with characteristic weakness of movements and sensitivity disturbances with respect to localization and severity of the lesion. At present, electrodiagnostic methods are the most useful in the diagnostics of the ulnar nerve lesions but neuroimaging (especially ultrasonography) is increasingly more often indicated. Chronic overburden with a damage of the ulnar nerve in the elbow is the second most frequent occupational mononeuropathy. This is why precise methodology for determination of ulnar nerve lesions in the elbow due to occupational cause was developed. Variable approaches are used for surgical treatment of ulnar nerve lesions in the elbow or in the wrist and hand and the surgery is the appropriate and effective therapy in the majority of cases. [ABSTRACT FROM AUTHOR]

Copyright of General Practitioner / Praktický Lékař is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of our study was to analyze the results of Adam's forward bend test of asymmetry of paravertebral muscles in primary school children. Our intention was to identify the main parameters of growth and development which can predict the Adam's angle. To reach this goal, we have sampled 270 boys and 270 girls ageing six to fourteen years. These probands were the pupils of primary schools in the Litoměřice region of the Central Bohemia, Czech Republic. The gathered data include Adam's angle, body height, body weight, computed BMI, age and sex. In our sample set, we have found the positive Adam's angle, higher than five degrees, in 27 samples (5,0 %). This number is slightly higher than previously reported data from the Czech children population. By linear regression analysis we have pinpointed the increasing age and body height as the main predictors for positive Adam's angle in our data set. Positive Adam's angle was also found more frequently in girls then in boys, the ratio was 2,4 :1 Body height, body weight and BMI from our data set were compared to these of the 6. National Anthropologica Survey of Children and Youth from 2001. We didn't find the two data sets statistically different. Therefore our data can confirm the fading of secular trend in Czech children. Adam's forward bend test is a fast and straightforward screening method, which can detect scoliotic deformity of the spine. [ABSTRACT FROM AUTHOR]

The authors present two clinical cases of young women with pseudotumor cerebri, which manifested with a tension headache and transient visual disturbance. Normal findings on the neurological examination and the unspecified imaging findings were found in both cases. Optic disc edemas were found in both patients and subsequent lumbar puncture revealed intracranial hypertension. The symptoms and findings on the fundus oculi progressed despite of complex conservative therapy and repeated lumbar puncture. Ventriculoperitoneal shunt was inserted to both patients with improving of visual disturbances and stabilization of condition. [ABSTRACT FROM AUTHOR]

Rapidly progressive movement disorder of the eye bulb associated with pain is a rare clinical presentation, which requires prompt diagnostics and therapy. Painful ophtalmoplegia appears in case of the lesion of cavernous sinus, extraocular muscles or retrobulbar tissue, but could be caused also by the damage of the brainstem. Although modern imaging modalities such as CT, MRI and neurophysiological examination are available, the diagnostic process is not simple. Moreover the prognosis is not often favourable. Both patients admitted at our department, suffering from painful ophtalmoplegia, required complicated diagnostic process, but had favourable outcome, which was a proposal for our publication. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.

Laparoscopic approach predominates in almost all surgical procedures. In comparison with classical surgery the laparoscopic procedures are more considerable for most tissues. Nevertheless, after learning of laparoscopic surgical techniques, iatrogenic peripheral nerve lesions still occure. The authors present a review of the most frequent laparoscopic operations and occurrence of peripheral nerve injuries in particular procedures. They try to point to the situations leading to iatrogenic lesions, to identify different causes of nerve damage and to deduce necessary preventive measures.

Peripheral nerves in obstetrics and gynecology are damaged with moderate frequency. Mostly there are iatrogenic lesions, that most often develop during delivery, operations and also in course of smaller invasive procedures. In genitofemoral nerve lesions neuralgic pain in groin and vulva is the most striking symptom, in cutaneous femoris lateralis nerve damage there are unpleasant paresthesias of lateral thigh. In case of femoral or obturator nerve lesion a weakness of thigh muscles with difficulties of standing and walking is the most typical. In pudendal nerve damage the autonomic disturbances (incontinence of feaces and urine) and pain in perineum are in the foreground of the patient's complains. After a knowledgeable history taking and detailed clinical examination the next step of diagnostics are neurophysiological investigations (neurography and needle electomyography). In special cases there is racional to use imaging methods (ultrasonography, MRI, CT). In majority of these iatrogennic nerve lesions the conservative approach is successful (rehabilitation, medicaments against neuropathic pain) and only in a small proportion of patients the neurosurgeon consultation is necessary.

Purpose of the Study: Injury to the spinal chord at the C5 level results in a severe handicap to the patient because of a loss of active motion of the wrist and hand. Selected surgical procedures can effectively restore active extension of the wrist and provide conditions for some vital pinching and gripping abilities. The deltoid muscle also has a potential for restoration of upper limb function, because its posterior portion can be used to restore elbow extension. The aim of this clinical retrospective study was to describe and evaluate the techniques used to improve the quality of life in patients with spinal chord lesions at the C5 level., Material and Methods: The group studied consisted of 15 patients (3 women and 12 men; average age, 34 years) with a spinal chord lesion at the C5 segment who had zero wrist extension or in whom wrist extensor muscle force was equal to the third degree of muscle strength or less. The procedures to restore active extension of the wrist involved the radiobrachialis muscle, the reconstruction of elbow extension was activated by the posterior portion of the deltoid muscle, and a fixed supination posture of the forearm was corrected by elongating the distal tendon of the biceps muscle which was derotated and attached to the proximal radius. The interval between injury and reconstructive surgery was 36 months on the average., Results: The reconstructive surgery described resulted in restoration of hand and wrist function with sufficient muscle strength in all patients, which had a favourable effect on many aspects of their daily lives. The average values of muscle strength were 4.1° (3° to 5°). for wrist extension and 3.3° (2° to 4°) for elbow extension. Key-pinch force was on average 1.2 kg (0.2 to 2.1). A failure of thumb carpometacarpal arthrodesis was the most frequent complication and occurred in two patients. On clinical evaluation, all patients reported satisfaction with the restored function of their upper extremities and expressed their willingness to undergo the same procedure again., Discussion: Reconstructive surgery of the upper extremity in tetraplegic patients has been performed with success in several countries, namely USA and Sweden, for many years. Since 2003 the results in the Czech Republic have also shown positive effects of reconstructive procedures on better quality of life in patients with cervical spinal chord injury at the lower levels, in whom the goal is to restore vital pinching and gripping abilities. A good outcome of surgical treatment requires good quality post-operative care provided by a team of physical therapists fully informed of the reconstructive procedures involved., Conclusions: A restored function of the upper extremity in the patients with spinal chord injury at the C level plays a decisive role in the whole spectrum of the patient's daily activities, such as dressing, communication, etc., and thus improves their self- care. The restoration of active elbow extension has a positive effect on the patient's mobility.

Compression of suprascapular nerve at the suprascapular notch or spinoglenoid notch can be a cause of a rare mononeuropathy. Patients complain of pain in scapula and shoulder, and selective wasting and weakness of the supraspinatus and infraspinatus muscles. Tenderness at the suprascapular notch and pain by forced abduction of arm are typical and useful signs. Electromyographic signs of various grade denervation are regularly found in both muscles. Development of entrapment syndromes is associated with chronic overload, shoulder injuries, with surgical procedures, or with shoulder-arm fixation. The authors present their own group of 10 patients, who were operated on for entrapment syndrome of suprascapular nerve during 7 year period. Direct or indirect traumatic mechanisms of development of nerve compression were disclosed in most patients. During postoperative period there was not only substantial decrease of pain, but also regression of weakness and wasting of both muscles. In discussion, necessity of differential diagnostic procedures in case of pain and muscle wasting, use of appropriate imaging techniques, demand of purposeful EMG examination, and postoperative follow-ups are emphasized.

The usefulness of carpal tunnel pressures measurement during surgery of carpal tunnel syndrome is documented by the authors. 31 patients underwent endoscopic uniportal approach, the pressure in different positions (neutral position, flexion and extension in wrist, grip of the fingers) and in different levels (distal forearm, proximal, central and distal part of carpal tunnel, palm) was measured. The significant drop of pressure was observed after dissection of ligament in all levels. The results are presented in the form of several graphs.

Granulomatous myopathies are extremely rare. The finding of epithelioid granulomas in muscle biopsy indicates mostly an involvement of the skeletal muscle in systemic sarcoidosis. In this report we provide description of five patients with previously diagnosed sarcoidosis (pulmonary or cutaneous), in which a clinically significant muscle weakness developed. We aim at demonstrating the value of muscle biopsy for further treatment of the patients, since clinically indistinguishable myopathies can arise not due to the involvement of muscles in the granulomatous process, but due to the corticosteroid-induced changes (chronic steroid myopathy). The demonstration of a selective atrophy of type II muscle fibers can provide the clue for distinguishing the patients, in which the corticosteroid treatment should continue, from those, in which the treatment should be modified. Further, we discuss a rare finding of granulomas in muscle biopsies of two patients with myasthenia gravis (MG) associated with thymoma. Although it is difficult to explain the pathogenesis of this event, MG should be considered in the differential diagnosis of granulomatous myopathies. Moreover, the finding of granulomas along with lymphocytic infiltration in MG muscle should lead to a search for an underlying thymic neoplasm.

DNA profiling--inclusive sex determination-- with microsatellite markers is currently a commonly used genetic method of studying humans. An efficient technique of producing the genetic data is amplification of multiple microsatellites in a single PCR reaction. Here we introduce a novel PCR-multiplex system for analysis of four polymorphic Y-STRs. Specifically, these are DYS449, DYS456, DYS458, and DYS464. These loci were chosen because of their reported high diversity in Euroamerican population (10), as well as their absence in the commercial analytical kits at the time of beginning of this study. Our objective was to design this PCR-multiplex for use of fragmentation analysis by electrophoresing samples on a capillary semi-automated genetic analyzer applying only one fluorescent dye. The PCR system we propose, may be notably used in fields such as forensic and human population genetics.

A significance of carpal tunnel pressure measurement during surgery of carpal tunnel syndrome (endoscopic and twin incision technique) was evaluated. The pressure in different levels of palm and in different positions of the hand was measured by ICP sensor Codman during operation of 10 patient. The results are presented in the form of several graphs. In all 10 cases excellent results were obtained.

The authors describe their experience with surgery of suspected TOS (8 cases) and traumatic TOS after clavicular fracture (1 case) in the last 2 years. In the group there were 7 women and 2 men aged 39-59 years with a history from 6 months to 26 years. Seven patients reported complete or almost complete relief of symptoms. In one case we observed progressive deterioration during 6 weeks postoperatively. All patients underwent decompression of the brachial plexus and subclavian artery from a supraclavicular approach. There was one case of reoperation after 15 years after primary surgery.

The authors present a group of patients operated on account of the carpal tunnel syndrome in 1998-2000 at the Neurosurgical department in Pardubice. The group comprised 37 patients. 15 men and 22 women. The main objective of the retrospective investigation was to assess the period of work incapacity and asset of the operation from the aspect to proceed with the usual workload. The authors also tried to evaluate the effect of age, sex, occupation, preoperative clinical and electromyographic finding on the resulting effect of the operation. The period of work incapacity after one operation was 114 days. 84% patients returned to their original job. In 11% it was necessary to enlist in different work and a disability pension was granted to 5% patients. The discussion is focused on the period of work incapacity, enlistment in work, the effect of operation on the patients complaints and the objective finding as regards the lesion of fibres of the median nerve and also on the asset of EMG in the diagnosis and postoperative follow up.

Dysphagia is frequently encountered in patients with acute affections of the nervous system (cerebrovascular attacks, craniocerebral injuries) and in chronic nervous diseases (amyotrophic lateral sclerosis, Parkinson s disease, dementia). To these patients enteral nutrition must be administered. If the perspective of dysphagia is short (several days) then nutrition by a nasogastric tube is fully indicated and sufficient. In cases of more prolonged dysphagia and in patients with a long perspective of dysphagia percutaneous endoscopic gastrostomy (PEG) is indicated. Both these methods of enteral nutrition have their advantages and disadvantages which are manifested in different ways in patients with disorders of the nervous system. The authors compared 62 patients hospitalized in the course of 4.5 years at the neurological department who had PEG with 72 patients who had nasogastric tubes and were hospitalized at the neurological intensive care unit in the course of one year. The authors evaluated the different indications for application, the incidence of complications and the advantages and disadvantages of the two methods.

Percutaneous endoscopic gastrostomy (PEG) is an efficient endoscopic method that ensures enteral nutrition for a longer period of time in patients who cannot take food per os. This method is also indicated in patients suffering from disorders of the central or peripheral nervous system which developed suddenly, such as a stroke or craniocerebral injuries, or gradually, such as amyotrophic lateral sclerosis (ALS), dementia, and multiple sclerosis. It has become common practice in the cooperation between neurologists and a gastroenterologists to use PEG in patients hospitalized in a neurological ward with encephalomalacy and haemorrhage, or craniocerebral injuries (after the patient recovers from the acute stage of the disease and is transferred to a neurological ICU), as well as in patients with ALS in a progressive stage. We gradually extend the indications of PEG for other patients with neurological disorders such as patients suffering from dementia, progressive multiple sclerosis, Parkinson's disease, and progressive polyneuropathy. Of 62 patients hospitalized in a neurological ward during a period of 4.5 years, 56 patients suffered from sudden disorders of the nervous system (strokes and craniocerebral injuries) and 6 patients had gradually progressing neurological diseases (ALS, multiple sclerosis, Parkinson's disease, dementia, and polyneuropathy).

A group of 37 workers exposed to styrene used in the plastic mass manufacture was investigated. No damage of the hepatic parenchyma, hematopoiesis or other internal affection was proved; irritative styrene effects were, however, observed, skin was attacked and higher genetic risk was evidenced. From the viewpoint of neurotoxicology, pseudoneurasthenic syndromes, predominantly inhibitory, could be seen, which was proved also by electroencephalography; higher incidence of lesion findings was also found in the risk group. Slight neuropathies of distal type, sensitive-motor, not dependent on the length of exposure were found by electromyography. Abnormalities in electrophysiological examinations appear earlier. The results obtained are significant for further preventive follow-up of persons under exposure.

The author summarizes his experience with diseases of the locomotor system of the extremities caused by long-term, excessive unilateral overload (item 29 of the Czechoslovak "List of occupational diseases") assembled during the period 1976 to 1987. In the department for occupational diseases of the District Institute of National Health Pardubice 349 subjects were examined where the disease was suspected, in 93 workers the occupational affection was notified. From a total of 2,294 notified occupational during the above period disease due to overload accounted for 4.1%. The cause of the affection was most frequently bursitis (32x), epicondylitis (25x) and carpal tunnel syndromes (24x), other affections being less frequent. The author analyzed the results with regard to sex, age, period of exposure, occupation. Special attention was devoted to glass workers who accounted for 51.6% of all affected subjects. The author discusses possible neurological affections, i. e. damage of the peripheral nerves. In the assessment of disease caused by overload the authors emphasized the importance of close cooperation of specialists for occupational diseases, neurologists, orthopaedists, physiologists and specialists in hygiene of work.

Twenty-five patients with symptoms of proximal diabetic neuropathy were examined and treated according to a simple pattern. Among anamnestic data myalgia proved most important (100%), as well as its character and localization. Important symptoms include: the presence of type II diabetes (72%) or recent diabetes (28%), loss of body weight (64%), weakness of the lower extremities and psychic changes (68%). In the clinical picture pareses in the femoral area and buttocks with increasing atrophy of these muscles (100%) are in the foreground. Muscular pain on pressure and changes of reflexes L2-L4 (80%) are typical. As to auxiliary examinations, a decisive role is played by EMG examination which proves the presence of proximal neuropathy. Other auxiliary examinations do not confirm findings which are essential for the establishment of the diagnosis of proximal diabetic neuropathy and serve differential diagnostic purposes.

The author examined groups of 25 diabetics with proximal diabetic neuropathy, 25 with distal diabetic neuropathy and a control group of 25 healthy subjects. Lesions of the femoral nerve in patients with proximal diabetic neuropathy are characterized by the presence of denervation potentials (80%) and changes of action potentials in the m. quadriceps femoris, a change in the shape of the M-response (only 12% within the normal range) and a reduction of the terminal conduction rate of the femoral nerve (34 +/- 12.3 m/s). In the discussion the author draws attention to technical and anatomical problems of the examination of the femoral nerve and to the interpretation of results with regard to the pathogenesis and clinical aspects. The recommended method of EMG examination of the femoral nerve is technically easy even for EMG laboratories which possess only simple equipment.

The author presents in his review information on contemporary possibilities in the treatment of diabetic neuropathy. This treatment is focused on strict compensation of diabetes, on support of the metabolism in the peripheral nerves and on symptomatic relief of the patient's complaints. Treatment of diabetic autonomic neuropathy which is so far only symptomatic, still remains a problem.