Nocturnal hypoxia has been observed in many cases of the patients with progressive muscular dystrophy. Nine patients with respiratory failure were treated by nasal intermittent positive pressure ventilation (NIPPV). The diagnosis was Duchenne muscular distrophy in six cases, myotonic dystrophy in two cases and limb-girdle distrophy in one case, and the period of follow up was from 114 to 568 days. The criteria of starting NIPPV were following; acute respiratory failure due to pneumonia or pulmonary infarction, and chronic respiratory failure with severe nocturnal hypoxia. Volume type ventilator and nasal mask system (Respironiks, Inc.) was used and the mouth guard and closing mouth prevented the airleakage from the mouth. NIPPV was applied only in the night in 8 cases and both the day and night in one case.
In all patients, hypoxia and hypercapnea soon improved in not only during nighttime but also daytime, and NIPPV were tolerated well. The only complication of NIPPV observed was slight skin erosion at the bas of nose by nasal mask in seven patients, which was not severe.
NIPPV was not invasive in comparison with ventilation via tracheostomy, and more effective than cuirass respirator. It was suggested that NIPPV was useful in the post operative management after extubation of endotracheal tube, and postponed tracheostomy.

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The mechanically elicited Achilles tendon reflexes (T-reflex) were examined in the normal subjects and the patients with upper or lower neuron lesion. T-reflexes were recorded by eight channels simultaneously, three bipolar recordings and five monopolar recordings with the indifferential electrode on the wrist. Bipolar recordings were carried out over the belly of gastrocnemius muscle. Monopolar recordings were from three sites over the muscle belly, and two on the foot (medial malleolus (MM) and metatarsophalangeal (MP) joint of the great toe).
Forty-one patients with lumbar disc herniation and twenty patients with hemiplegia have been studied and were compared with fourteen normal subjects. In patients with lumbar disc herniation, Achilles tendon reflexes of the affected side were decreased in eighteen, absent in five and normal in the remaining subjects. However, in all hemiplegic patients Achilles tendon reflexes of the affected side were increased.
The monopolar recordings of T-reflexes, especially from the MM and MP joint of the great toe, were much more constant in waveform than the bipolar recordings. In the affected side of the patients with lumbar disc herniation, who had showed decreased Achilles tendon reflexes, the amplitude of T-reflexes were decreased but not statistically significant in the absolute value. The amplitude ratio of T-reflexes of the affected side to the unaffected side was significantly decreased compared with that of the left to right ratio in the normal subjects. Although some degree of the delay was expected in the onset latency of the patients with S1 root involvement, any significant delay was not observed in this study, even in the patients with decreased Achilles tendon reflexes. It is posturated that the effect of the disc herniation was not severe enough to produce any significant delay. In the patients with hemiplegia the amplitude of T-reflex in the affected side was markedly increased, and the amplitude ratio showed a significant difference.
It is concluded that the amplitude ratio of T-reflex reflected the patient's clinical pictures. The monopolar recording of T-reflex would be useful as an objective measurement in evaluation of the Achilles tendon reflex.

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[in Japanese]

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