BACKGROUND: Neuromuscular ultrasound has emerged over the last decade as a useful tool for diagnosing peripheral neuropathy. Because nerve enlargement is the most important diagnostic marker of an abnormal nerve, quantification of nerve size is essential. METHODS: We included 80 healthy volunteers aged 21-60 years. The nerve cross-sectional area (CSA) was measured in all participants at the following common compressive sites: bilateral median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head and popliteal fossa, and tibial nerve at the popliteal fossa. Anatomical variants were also evaluated, including a bifid median nerve and persistent median artery. RESULTS: The CSAs were 9.58+/-1.55, 6.87+/-1.61, 4.72+/-0.91, 6.64+/-1.33, 6.48+/-1.68, 12.35+/-3.55, and 26.98+/-6.92 mm2 (mean+/-SD) for the median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head, and tibial nerve at the popliteal fossa, respectively. The nerve CSA was significantly larger in men than in women and was correlated with body mass index, weight, and height. A bifid median nerve and persistent median artery were seen in 12 (7.5%) and 4 (2.5%) of 160 hands, respectively. CONCLUSIONS: The information produced in this study can serve as reference data when evaluating these nerve sites using ultrasound.
Arteries ; Body Mass Index ; Female ; Forearm ; Hand ; Head ; Healthy Volunteers ; Humans ; Male ; Median Nerve ; Nerve Compression Syndromes ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Radial Nerve ; Reference Values* ; Tibial Nerve ; Ulnar Nerve ; Ultrasonography ; Wrist

OBJECTIVE: The biochemical data of 10 patients admitted with diabetic ketoacidosis(DKA) during the last 2 years were analyzed for the disturbances of serum potassium(K) and acid-base balance with a special interest to look for the underlying causes of potassium(K) disorder, retrospectively. METHODS: Arterial blood gas analysis was done and electrolytes, serum glucose, serum osmolality, BUN, creatinine were checked on admission and recovery in 10 patients with diabetic ketoacidosis. RESULTS: The mean(+/-SE) serum K at diagnosis and on recovery was 4.9+/-0.9mEq/L(range, 3.2-6.5 mEq/L) and 3.8+/-0.2mEq/L(range, 3.0-4.3mEq/L), respectively. Hyperkalemia(>5.0mEq/L) in 30%(3/10) and hypokalemia(<3.5mEq/L) in 10%(1/10) was noted on admission, whereas, on recovery, hyperkalemia in none and hypokalemia in 40%(4/10). Initial K levels showed a negative correlation with pH(gamma= -0.62, P=0.05) but no significant correlation was found between the initial K levels with anion gap (AG), with serum glucose value and with blood osmolality. Only 40%(4/10) had a simple metabolic acidosis while 60%(6/10) had a mixed acid-base disorder DKA with respiratory alkalosis, mostly(5/6). The ratio of delta AG over delta HCO3 was not significantly different between patients with a simple metabolic acidosis(0.95) and with a mixed acid-base disorder(0.92). CONCLUSION: The degree of acidosis must be one of the predominant factors in the pathogenesis of the initial hyperkalemia rather than hyperglycemia resulting from insulinopenia itself. Also, we observed that patients with DKA commonly develop mixed acid- base disorders, and delta AG/delta HCO3 ratio would not be an useful tool to look for a mixed acid-base disorder.
Acid-Base Equilibrium* ; Acidosis ; Alkalosis, Respiratory ; Blood Gas Analysis ; Blood Glucose ; Creatinine ; Diabetic Ketoacidosis ; Diagnosis ; Electrolytes ; Humans ; Hyperglycemia ; Hyperkalemia ; Hypokalemia ; Osmolar Concentration ; Potassium* ; Retrospective Studies

BACKGROUND: The bispectral index, a parameter of electroencephalography (EEG) and a tool for the measurement of sedative state has been used in general anesthesia and for the assessment of sedative degree in intensive care units. The adverse effects of inhalation agents are various although hepatic toxicity, renal toxicity, postoperative nausea, and vomiting have been reported. This study was designed to evaluate the adverse effect of inhalation agents. METHODS: Forty-four adult patients scheduled for thyroidectomy under general anesthesia were randomly assigned to one group with a BIS below 40 (BIS40 group, n = 23) or to a group with a BIS from 50 to 60 (BIS60 group, n = 21). Hgb, WBC count, PLT count, renal function, and liver function were measured pre-and post-operatively (after 24 hrs). The degree of postoperative nausea and vomiting were estimated using the Rhodes Index of Nausea, Vomiting and Retching (RINVR) in postoperative 6 hrs, 12 hrs and 24 hrs. RESULTS: The amount of fentanyl used during the operation were greates in the BIS60 group than in the BIS40 group for adequate analgesia, and the preoperative and postoperative values of Hgb, WBC count, PLT count, AST, ALT, ALP, s-BUN, and s-creatine were not significantly different between the BIS40 and BIS60 groups. 6 hrs, 12 hrs and 24 hrs post-operatively no differences were observed between groups by RINVR in terms of nausea and vomiting. CONCLUSIONS: The adverse effect of an inhalation agent appears not to be related to its concentration when sevoflurane with BIS monitoring are used to reduced the amount of agent inhaled.
Adult ; Analgesia ; Anesthesia* ; Anesthesia, General ; Electroencephalography ; Fentanyl ; Humans ; Inhalation ; Intensive Care Units ; Liver ; Nausea ; Postoperative Nausea and Vomiting ; Thyroidectomy ; Vomiting

No abstract available.
Humans ; Longitudinal Ligaments* ; Magnetic Resonance Imaging* ; Spine*

No abstract available.
Compartment Syndromes*

Brief ischemic episodes that induce myocardial and coronary endothelial dysfunction may alter the responses to inotropic drugs. To determine the effects of inotropic drugs in stunned myocardium, the coronary blood flow (CBF), myocardial oxygen consumption (MVO2), and regional mechanical function in response to intracoronary dobutamine, epinephrine, amrinone, and calcium chloride (CaCl2) were measured before (normal) and 30 min after a 15-min-period occlusion of the left anterior descending artery (stunned) in an open-chest canine model. Percent segment shortening (%SS) and post-systolic shortening (%PSS) were determined. Myocardial extraction of oxygen (EO2) and lactate (E(lac)) was calculated. The inotropic drugs increased %SS, CBF, and MVO2 in normal myocardium. Epinephrine and amrinone decreased, while dobutamine and CaCl2 did not affect EO2. The ischemia and reperfusion itself significantly reduced %SS and E(lac), and increased %PSS. In stunned myocardium, the responses to inotropic drugs were not significantly altered, except that they progressively reduced %PSS and epinephrine did not affect EO2. These findings indicate that a brief episode of ischemia does not affect the mechanical and metabolic coronary flow responses to inotropic drugs, although it abolishes direct vasodilator responses to epinephrine.
Amrinone/administration and dosage ; Animals ; Calcium Chloride/administration and dosage ; Cardiotonic Agents/*administration and dosage ; Comparative Study ; Dobutamine/administration and dosage ; Dogs ; Dose-Response Relationship, Drug ; Epinephrine/administration and dosage ; Female ; Male ; Myocardial Contraction/*drug effects ; Myocardial Stunning/*drug therapy/etiology/*physiopathology ; Oxidation-Reduction/drug effects ; Oxygen Consumption/*drug effects ; Reperfusion Injury/complications/*drug therapy/*physiopathology ; Treatment Outcome

OBJECTIVE: Morphometric data for the sympathetic ganglia (SG) of the upper thoracic spine was investigated to identify the exact location of the SG in order to reduce normal tissue injury in the thoracic cavity during thoracoscopic sympathectomy. METHODS: In 46 specimens from 23 formalin-fixed adult cadavers, the authors measured the shortest distance from the medial margin of the T1, T2 and T3 SG to the most prominent point and medial margin of the corresponding rib heads, and to the lateral margin of the longus colli muscle. In addition, the distance between the most prominent point of the rib head and the lateral margin of longus colli muscle and the width of each SG were measured. RESULTS: The shortest distance from the medial margin of the SG to the prominent point of corresponding rib head was on average 1.9 mm on T1, 4.2 mm, and 4.1 mm on T2, T3. The distance from the medial margin of the SG to the medial margin of the corresponding rib head was 4.2 mm on T1, 5.9 mm, and 6.3 mm on T2, T3. The mean distance from the medial margin of the SG to the lateral margin of the longus colli muscle was 6.7 mm on T1, 8.8 mm, 9.9 and mm on T2, T3. The mean distance between the prominent point of the rib head and the lateral margin of the longus colli muscle was 4.8 mm on T1, 4.6 mm, and 5.9 mm on T2, T3. The mean width of SG was 6.1 mm on T1, 4.1 mm, and 3.1 mm on T2, T3. CONCLUSION: We present morphometric data to assist in surgical planning and the localization of the upper thoracic SG during thoracoscopic sympathectomy.
Adult ; Cadaver ; Ganglia, Sympathetic ; Head ; Humans ; Muscles ; Ribs ; Spine ; Sympathectomy ; Thoracic Cavity ; Thoracic Vertebrae ; Thoracoscopy

Amlodipine, nifedipine, and felodipine are calcium channel blocking agents, which are cause of unwanted gingival overgrowth around natural teeth. Many studies has been performed about this unwanted effects. However, the exact etiology remains uncertain.Few reports and investigations can be found in the literature on drug-induced gingival overgrowth around dental implants. The present case reports that amlodipine-induced gingival overgrowth occurred in peri-implant sites, confirms clinical and histological features in hyperplastic peri-implant tissues. Clinical and histological features of amlodipine-induced gingival overgrowth around dental implants were similar to that of tissue around natural teeth.

Amlodipine, nifedipine, and felodipine are calcium channel blocking agents, which are cause of unwanted gingival overgrowth around natural teeth. Many studies has been performed about this unwanted effects. However, the exact etiology remains uncertain.Few reports and investigations can be found in the literature on drug-induced gingival overgrowth around dental implants. The present case reports that amlodipine-induced gingival overgrowth occurred in peri-implant sites, confirms clinical and histological features in hyperplastic peri-implant tissues. Clinical and histological features of amlodipine-induced gingival overgrowth around dental implants were similar to that of tissue around natural teeth.

BACKGROUND: Propofol has a high incidence of pain when administered by intravenous injection. Among the many different methods available, lidocaine is used most frequently to minimize this pain. Propofol also has a depressant action on hemodynamics, especially in the elderly. The present study was aimed to examine whether lidocaine affects hemodynamic changes associated with propofol injection and endotracheal intubation, and whether it attenuates propofol-induced pain. METHODS: Eighty patients, over 60 years old, ASA physical status I and II, were randomly divided into four groups of 20 each according to lidocaine dosage mixed with 2 mg/kg of propofol given over 30 seconds during the induction of anesthesia; 0 mg (control group), 20 mg, 40 mg and 80 mg. Mean arterial blood pressure (MAP), heart rate (HR), and bispectral index scale (BIS) were measured before anesthetic induction (baseline value), 1 minute after the start of induction, immediately before endotracheal intubation, and then every minute for 5 minutes. Injection pain was scored as none, mild, moderate, or severe. RESULTS: MAP decreased significantly following the propofol injection and then increased after endotracheal intubation in all four groups, the magnitude of this decrease did not differ among the groups. HR increased after the propofol injection and then decreased. It increased again after intubation in all four groups. BIS was decreased by the induction of anesthesia, but was not affected by endotracheal intubation in any group. The three lidocaine groups had a lower incidence and severity of propofol-induced pain than the control group, and the effect were comparable among the lidocaine-treated groups. CONCLUSIONS: Our results indicate that lidocaine 20, 40 or 80 mg mixed with propofol does not affect the hemodynamic changes associated with propofol and endotracheal intubation, but that they similarly attenuate the injection pain associated with propofol.
Aged* ; Anesthesia* ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Lidocaine* ; Middle Aged ; Propofol